The best ear drops for ear plugs

*Review of the best according to the editorial board. About the selection criteria. This material is subjective, not intended as an advertisement and is not intended as a guide to purchase. Consultation with a specialist is necessary before buying.

In medicine, there are not only global problems, such as the pandemic coronavirus infection, the spread of HIV and AIDS, the “rejuvenation” of heart attacks and strokes. There are other medical questions, less important for the survival of the population, but very important for each person, to which each of us seeks his or her own answers.

One such issue is the problem of earwax, or wax plugs. It is relevant in all countries of the world. Babies are already born with wax plugs, and one in five newborns needs their ear canals cleaned. According to Turkish researchers, 6 to 7% of all children in elementary school have ear plugs in both ear canals, and the same statistics for our country gives about 4% of the population, which is probably lower than the actual numbers.

Man, like any open system, is in constant interaction with the environment. A person ingests food, water, breathes air. It secretes carbon dioxide, liquid and dense waste products of its vital functions. The skin secretes sweat, and earwax is secreted from the external ear canal.

But is earwax considered a normal waste? Why do we see it so seldom?? Is it too slow, or irregular, to blame?? Why do you need it at all?? Whether it has any useful function? And if it does, why isn’t it eliminated as calmly and regularly as other waste products? Why earwax plugs form, and can they be avoided with modern medicine? And if ear plugs have appeared, how to deal with them? Do drops help from ear plugs, and if they are, what? What other remedies are available, such as non-drug remedies, and how effective they are? All questions are interesting and necessary, but let’s start with the main one: why, in fact, do we need earwax??

Can excessive earwax and the formation of earwax plugs be called a fashionable term: “the disease of civilization”?? I think you can. It is known that humans differ from other mammals in a number of fundamental ways. For example, their mode of locomotion in the form of upright walking, their thumbs set back so that they can grasp things, and most importantly, their exceptionally large brain volume compared to their closest relatives.

Why does a person need earwax?

The change in the volume of the cerebral skull in the direction of increasing its volume has entailed a number of other anatomical changes in the surrounding organs, and this process has already begun in primitive primates. So, the auditory receptor-membrane in the form of the tympanic membrane began to lie deep, and rather narrow, auditory passages began to lead to it. But somehow it is necessary to serve them, to keep them clean? Yes, you do. This, paradoxically, is what the dirty and, at first glance, repulsive earwax is for.

The human external auditory canal is made up of two different structures. Closer to the surface of the skin, the external auditory orifice, its walls contain no bone tissue, and are called the membranous-cartilaginous part. And then closer to the eardrum, there’s the bony part of the eardrum. And between the transition of the cartilaginous part to the bone part, there is a narrow place, the so-called isthmus. Ear wax is only produced in the outer ear canal; it is no longer secreted in the bony region.

It should be noted at once that the common practice among adults and children of cleaning their ears with cotton swabs is very harmful. Not knowing about the existence of an anatomically narrow isthmus between the two parts of the external auditory canal, parents simply push their children’s wax masses deeper, beyond the isthmus. As a result, the wax masses thicken deep behind the isthmus, are pressed, and this attempt to clean with cotton swabs ear wax leads to the opposite effect: the formation of ear plugs.

Earwax consists of the secretion of the sebaceous glands located in the external auditory canal. In addition to the secretion there is the sloughing epithelium, which dies out in the same anatomic borders. This epithelium is bound by the sebum, and as a result the wax becomes insoluble in water, since sebum consists mainly of lipids.

Also in the composition of earwax are various glycopeptides, enzymes, various immunoglobulins, hyaluronic acid. The sebaceous glands in the external auditory canal produce normal sebum similar to that found on the rest of the skin. But there are special wax glands that lie deeper under the skin of the external auditory canal. Their secret is a special white milky fluid that is added to the sebum.

Interestingly, a person’s nationality and race affects the secretion of earwax. Historically, African-Americans and Caucasians have more lipids in their earwax, which is called wet earwax. The Mongoloid race has less of these lipids, and their sulfur is of a drier consistency.

If there are no obstacles to the removal of the earwax, it is beneficial. The task of earwax is to protect the external auditory canal from inflammation, and to heal the resulting damage as quickly as possible. In addition to its bactericidal properties, earwax well protects the external auditory canal from water, thanks to the presence of lipids. In general, earwax has an acid-base balance shifted to the acidic side, this environment suppresses the growth of harmful bacteria and fungi in a healthy person.

But why does such useful earwax form plugs, and not excrete on its own, so to speak, routinely?

Causes of ear plugs

In a healthy person, the formation of earwax is a natural process, and cleaning the external ear canal of accumulated wax masses is associated with movement in the temporomandibular joint. This occurs when talking, chewing, and swallowing. The movements of this joint are transmitted to the supple, elastic cartilaginous part of the external auditory canal. These rhythmic movements simply mechanically push the wax outward. But when there is an increased secretion of wax, or difficulty in removing it, that’s when the plugs occur.

Risk factors for ear plugs are:

1. Certain congenital features of the external auditory canal, such as its relative narrowness, or tortuosity;
2. The presence of developed hairiness inside the auditory canal;
3. old age, in which all processes in the body are slowed down, or, on the contrary, a newly born baby, who immediately needs to perform a toilet of the external auditory canal;
4. Environmental factors that contribute to the thickening and drying of the wax, or on the contrary, its swelling and retention inside the ear canal.

These are high temperature, humidity, changes in atmospheric pressure. Especially important is such an industrial factor of harm, such as dustiness. This could be sandblasting, working with cement, or even wheat flour.

Other causes that lead to the accumulation of wax plugs are as follows:

1. Abuse of cotton swabs and trying to clean your ears regularly. We have already talked about the fact that it leads to a mechanical pushing of the wax deep inside. But too frequent and vigorous brushing with chopsticks additionally irritates the inner surface of the auditory canal, and more wax is released, and then it is also “successfully” pushed inside and tamped down;
2. Various diseases of the ear. And first of all, eczema of the external auditory canal, dermatitis, including psoriasis, chronic suppurative otitis media. Skin diseases lead to an increase in the number of sloughing scales, an increase in the total volume of sulfur. In the case of chronic otitis media, and even with a perforated eardrum, an inflammatory exudate is periodically discharged from the ear, which additionally adheres to the wax, and leads to very dense, “glued” with a lot of protein plugs;
3. Foreign body of the external auditory canal. This is especially true for babies.

Additionally, it may be recalled that an exacerbation of chronic otitis media results in inflammatory swelling, leading to narrowing of the auditory canal lumen. This is an additional anatomical obstacle to the normal expulsion of wax.

Signs of earwax

If an ear plug does occur, it can be either small or large. But even a large plug may not completely block the entire lumen of the external auditory canal, and then hearing will not suffer, remain normal, and in normal life the person will not feel anything and feel no discomfort. But as soon as you take a shower, swim, the plug gets water, sulfur immediately swells, and the well-known symptoms arise. This:

1. Sudden and dramatic hearing loss in one ear;
2. Blockage in the ear;
3. In the elderly, people assess this condition as the appearance of a sudden noise on the side of the plug.

But a swollen plug is not only bad for your hearing. A sharp increase in the volume of wax may press inward, on the eardrum, and through it, on the mucosa of the tympanic cavity. It is richly supplied with various nerve endings, such as the branches of the pharyngeal nerve, and the constant pressure can cause serious symptoms:

1. the patient has headaches, or cephalgia of a reflex nature, and dizziness;
2. Often, the cough reflex becomes active, and fits of unintelligible coughing occur;
3. In severe cases, there may be nausea, as well as vomiting unrelated to food intake;
4. pain and discomfort in the ear may appear;
5. In severe cases, there may even be heart rhythm disturbances, changes in blood pressure, and seizures.

Diagnosis

To diagnose a wax plug can be a doctor otolaryngologist, for this he needs at least a regular ear funnel and a headlight for otoscopy. In some cases, a special microscope is needed to perform otomicroscopy and examine the eardrum in detail. Finding out if the eardrum is intact is very important. For example, if there is its perforation due to chronic otitis media, then some methods of treatment and removal of the ear plug will become inapplicable.

In the presence of a plug, the ENT doctor necessarily pays attention to its size, localization, and when trying to touch it with a microspatula or loop, it is very important to assess its consistency in order to understand how best to remove it.

Cork can be either soft or dry:

1. Soft cork can have a rather viscous consistency (pasty, plasticine), similar to dense honey, have a color in which yellow shades predominate: light yellow, dark yellow, or honey-yellow. These plugs are malleable and usually do not cause any problems. Also soft cork may resemble plasticine rather than paste, but still be viscous and pliable;
2. Finally, when you have dry plugs, the doctor will have the most work to do. They are always dark brown or completely black, unyielding, and their consistency is hard and dense.

How to get rid of an ear plug?

Removal of ear plugs

The doctor at the initial appointment determines the method of removing the plug. After collecting the anamnesis and examination, determining the hardness of the plug, you can directly remove the plug at the reception, or you can try to do it on an outpatient basis, using special drops and medications that soften and dissolve ear plugs. About what drops and sprays for removing ear plugs exist, we will tell you later, these drops the patient drops at home. And how can the doctor remove the plug at the office?? Here are the ways.

Irrigation

This is the easiest way to remove a soft wax plug, or try to remove a hard one. Warm water is used for this. Irrigation can be done if and only if there is no perforation of the tympanic membrane, and the patient has no purulent otitis media. Just pouring warm water into the ear is not very effective, a strong stream of water at a pressure is necessary. And for this, a large Jeanne syringe is used. Yes, this is the very same syringe used to give a shot to Morgunov, the Byvalomu, in the cult Soviet film The Prisoner of the Caucasus.

It takes some skill to remove the plug under pressure, but an ENT nurse can also do this. The patient sits sideways to the nurse, and holds a kidney-shaped tray under their ear into which the water will drain. The tip of the syringe is gently pushed in very shallowly into the ear canal and pushed toward the back top, toward the wall of the canal with the same name. After that a strong and even stream of water is directed there.

If the patient is successful the ear plug either disintegrates or even falls out as a whole into the tray as a small cylindrical stick. In some cases it needs to be repeated several times. For greater efficacy, the ear should be dripped before the lavage, or a turunda moistened with a warm 3% hydrogen peroxide solution should be inserted. This will partially dissolve the plug and make it easier to rinse.

In some cases, when the plug is dense and could not be removed immediately, even by several flushes and softening with hydrogen peroxide, the patient may be prescribed ear plug drops to be used as an outpatient at home for two to three days and then come back for a flush. This usually works.

Aspiration-suction

If the ear plug has already become mobile but is still somehow clinging to the wall of the external ear canal, then you can try to gently suck it out by creating negative pressure. In the simplest case this is a normal small ear syringe. But you can also use a special device, the usual electric suction pump. It is wonderful for soft wax plugs, and even for hard ones. But it must be used carefully, under visual control, and under no circumstances touch the eardrum, and act only in the lumen of the external auditory canal.

Curettage of the plug

It is to remove the plug with a special curette, or probe. As a rule, this method is the final one: it is used after the plug could not be removed with repeated rinsing. But, in some cases, lavage is prohibited, such as when there is a perforation of the eardrum.

In this case a special hook-shaped probe is needed, which is passed through the plug. Then the doctor pulls the probe towards himself, and the plug, after some resistance, leaves the external auditory canal. This is a medical procedure because a hole must first be made in the plug in order to introduce the probe. And the hole must be made in such a way as not to blindly damage the eardrum, this requires a fine technique and skill. Sometimes a hooked probe is also used to pick up and remove the tightly adhering residue of the plug that remains after rinsing.

In most cases, to remove the wax plug is enough only one visit to the doctor, and no more than half an hour to use all the methods. First it can be hydrogen peroxide that is put into the ear, then it can be a rinse, then it can be an attempt to extract the fragments of the plug, and finally it can be a curettage.

But if all these methods have had no effect, if the plug is hard and dry, then it is necessary to inject into the ear at home or:

1. hydrogen peroxide;
2. Special drops that allow you to either completely dissolve this unpleasant formation, or greatly soften it, and at your next visit to your doctor, remove the plug.

The best ear drops for ear plugs

Dissolving plugs with ear drops

Finally, we come to the pharmacological part. Consider what preparations can soften, dissolve earwax, and which drops are used. We will imply that the drops will work, just put into the ear. And then calmly, by turning the head, everything flows out on its own. We will not consider liquids and solutions that need to be injected into the ear under pressure, for example, with the same syringe.

In the outpatient, at home there are drops and there are sprays that penetrate the ear under pressure. But the pressure in the spray can is not comparable to the pressure in the Janet syringe, the spray is produced solely for convenience. No mechanical energy is released from the spray; the effect depends entirely on the chemical composition and the temperature of the medication.

On today’s market, there are several of these effective preparations, in the form of drops that, allow you to dissolve and remove the ear plug. Generally, they are contraindicated in children under 2 1/2 years of age. You must remember that complete dissolution of wax plugs does not occur in 100% of cases: according to some sources the effectiveness of the drops alone does not exceed 70%. Therefore, it is advisable to see a doctor-otolaryngologist after using them at home to permanently remove the plug.

This review presents drugs that are sold in pharmacies without a prescription. The inclusion of a drug in the list, or the omission of a drug in the list, is not advertising, or anti-advertising. All drops are taken from national and international recommendations, guidelines and protocols, for removing wax plugs. The information is solely informative, the source of information are the official instructions to the drops and sprays for removing ear plugs, located in the free access. For each drug, the name, characteristics, and price range relevant to November 2020 for pharmacies of all forms of ownership in the Russian Federation is given.

Water-based and oil-based preparations

Solvents are not able to remove hard and long-standing wax plugs, at best they can only soften it up a little. They should be used if the wax plug has a soft, plasticky consistency, and has formed recently. If the plug is very dense, it is better not to waste time with these products, as they are not specifically designed to dissolve plugs. However, in uncomplicated cases, you can try to start with these.

Aqua Maris Oto

Rating: 4.9

This medication is nothing more than usually seawater, it is sold in 100 ml vials. Water should be dripped into the external auditory canal using a special dispenser nozzle. Tilt the head sideways, to the right or to the left, depending on the ear. Insert the tip of the bottle into your ear canal, and press the nozzle for several seconds. Then you should wipe off the excess fluid with a tissue, and repeat the procedure for the other ear. This is how symmetrical, normal hygienic care of the external auditory canal is performed.

In adults and children, this remedy can be used once or twice a day, no more than three times a week, starting at the age of 4. If there are wax plugs, or excessive wax formation, this treatment is recommended daily. This drug is produced by the Croatian company Jadran, and the seawater is taken from ecologically clean areas of the Adriatic Sea, from great depths. The cost of a 30 ml can of Aqua Maris in the form of a metered spray will cost from 230 to 270 rubles.

Advantages and disadvantages

Since Aqua is ordinary seawater, it allows you to take care of the inner surface of the external auditory canal, wash off exfoliated residual epithelium in a timely manner, remove fresh wax before it is soaked in lipids and water-soluble. But once the sulfur has become hydrophobic and has begun to form plugs, seawater is unlikely to cope with such a dense and dried plug.

Also, Aqua Maris Oto, both spray and drops, is contraindicated if there is intense inflammation, perforation of the eardrum and if there is incomprehensible othalgia, that is, pain in the ear. All these situations need urgent medical consultation. Also, do not force the tip into the external ear canal to avoid injury and do not use cotton swabs to clean the external canal.

Therefore, it can be considered that this remedy is auxiliary, it can help remove soft plugs and prevent their formation, but the drug will not cope with hard plugs. It is also a little unusual that a small amount of seawater costs so much. It turns out that for a glass of sea water the consumer in the drugstore will pay 1750 rubles., When comparing volumes. Apparently, seawater even from ecologically clean places in the Adriatic would not be so expensive, otherwise it can be easily replaced by water salinated to the strength of 33 ppm.

Otinum (choline salicylate)

Rating: 4.8

These are the original ear drops from the German company Meda pharma, which are produced in Poland. These are choline salicylate solution, 20% strength, drops in a dropper bottle. The cost of 10 ml of such ear drops is from 205 to 400 rubles.

Choline salicylate is a derivative of the first non-steroidal anti-inflammatory compound, salicylic acid. If you drop it into the external auditory canal, it will fight inflammation and relieve pain. Like Aspirin, Paracetamol, or Xefocam, these drops inhibit the cyclooxygenase enzyme, which is responsible for the inflammation. It is important that choline salicylate also kills fungus and fights germs. If it is put in the ear, it will not be absorbed into the blood, which means the drops have no systemic action.

Otinum is indicated if a person has ear pain for different types of otitis media, such as acute or chronic, as well as otitis externa. The second indication for use is to soften hardened earwax, plugs, before removing them. We must stress once again: Otinum is not intended to dissolve wax plugs, but only to soften them. That is why the doctor who failed to remove the wax plug at an appointment may prescribe you Otinum drops for a few days and then, with a Janet syringe, flush the plug out of the ear with a strong stream of water.

Apply these drops to soften the wax plugs by 3-4 drops in the desired ear twice a day for 4 days. If it is an inflammatory process, painful sensations and otitis media, the drops are dropped not twice a day, but four times a day, but no longer than three days. Before dropping the drops into the ear, it is necessary to warm the bottle to room temperature, or better yet, to body temperature by holding the drops in your hands. As usual the drops are placed with the person lying on their side so the ear canal looks up.

Advantages and disadvantages

A big plus of this drug is that it is shown not only to dissolve the wax plugs, but also fights inflammation, disinfects and produces an analgesic effect. Therefore, these drops would be a good choice for those patients who have “ear problems” and suffer from chronic otitis media with various exacerbations. Then the relatively high price of these drops will be justified.

It is also important that the dose does not need to be adjusted for the elderly, children, and patients with kidney or liver dysfunction. Of the side effects, there may occasionally be hypersensitive reactions in the form of itching and redness of the skin of the external auditory canal. The official instruction reminds us that this remedy should not be used if the eardrum is perforated. Otinum is contraindicated in cases of intolerance to NSAIDs (aspirin asthma, nasal polyposis). It is not prescribed during pregnancy, while breastfeeding, or under the age of 1 year.

Hydrogen peroxide 3%

Rating: 4.7

Never use hydrogen peroxide stronger than 3% as an ear drench. Hydrogen peroxide refers to antiseptics, and is able to stop bleeding, albeit small, capillary. Hydrogen peroxide is a unique compound, with a very weak hydrogen-oxygen bond in its molecule. Once the hydrogen peroxide comes into contact with proteins, biological fluids (blood and pus, exudate, even saliva), it immediately releases active oxygen, which has a disinfectant effect. Pure oxygen does not kill microorganisms like a powerful antiseptic, it just temporarily reduces their number, and in this respect oxygen is a weak antiseptic. But hydrogen peroxide is excellent able to clean wounds mechanically, and inactivate various organic compounds.

That is why hydrogen peroxide is indispensable for washing various wounds, including postoperative and deep. And in the clinic of ENT diseases, it is widely used for an injection into the external auditory canal, provided, of course, that there is no perforation of the tympanic membrane.

You can buy hydrogen peroxide at any drugstore. At the same time, despite its high efficiency, versatility of use, its cost can be considered negligible compared to other drugs. You can buy one 100 ml bottle for less than 10 rubles., is an all-time record.

It is desirable to use hydrogen peroxide to soften the earwax once or twice a day for 3 days before the final visit to the ENT doctor. The peroxide must always be warmed to body temperature to avoid discomfort when injecting into the ear. As soon as warm hydrogen peroxide is put into the ear, it seems to “boil” there. It feels like it’s bubbling, bubbling, and getting even hotter. This is indeed true, at this time there is an exothermic reaction: the peroxide interacts with organic substances, bubbles of formed oxygen burst out of it, with the release of heat. It cleans and disinfects the ear canal and softens the wax plug.

Advantages and disadvantages

As in the previous cases, hydrogen peroxide is water-based droplets, and a dense sulfur plug is insoluble in water, so the maximum you can do with peroxide is to soften it slightly. But young and soft wax plugs can, with the help of hydrogen peroxide, fragment into separate pieces, which can then be easily washed out with a Janet syringe. In addition, hydrogen peroxide is extremely cheap, widely available, and a must-have in every home medicine cabinet, from disinfecting minor wounds to stopping minor bleeding, such as cuts after shaving. Therefore, we can safely recommend this cheap and very important preparation, it will not be superfluous.

Oil-based preparations

The previous drops were water-based. But, they could basically break down the earwax into its individual components, only in the case of its soft consistency or recent origin. Oily-based products are fat-soluble, so they are better able to emulsify, lubricate and soften the earwax lipids. Even though they can’t remove hard, stubborn wax plugs, they have about the same effect as water-soluble medications. From ancient times paraffin has been used for this purpose, even older use of almond, rose or olive oil. Nowadays there are some preparations, such as Klin-Irs on the basis of paraffin, or Vaxol on the basis of olive oil. But here we will talk about one product in drops – Remo-Vax.

Remo-Vax

Rating: 4.9

Remo-Vax was originally developed as a product specifically for the care of the skin of the auricle and ear canal. This product contains allantoin, phenylethanol, benzethonium chloride and other compounds. The solvent is liquid lanolin, which is obtained from sheep’s wool wash water, and mink oil. The successful combination created a hypoallergenic solution for earwax hygiene and removal of excess earwax. This medicine is also given while you are lying on your side, in warm condition, so that the ear canal looks up. To straighten the tortuous external auditory canal, grip the ear lobe and pull it down and backwards. Then, trying to hit the back wall of the ear canal, you need to put 15-20 drops, but not less than 10, to cover all the walls of the ear canal evenly.

Do not try to drip into the center of the hole, you may get an air clog and the drug will not penetrate in the right amount into the ear canal. Then wait 5 to 10 minutes, turn on your side, let the solution flow out quietly, and then wipe the ear with a towel or tissue. For hygienic purposes, it is enough to use once every 2 weeks, but in order to remove the wax plug, it is necessary to lie with the drops in the ear longer, up to 30 minutes. If the plug is extremely hard and strong, in some cases, the procedure will have to be repeated up to 5 times in a row. As a result, the exposure time can reach 2 hours, during which time any plug will soften and can be safely removed. Remo-Vax is produced by a French company Orion. A 10 ml spray can cost anything from 370 to 460 rubles. Drops of the same volume (10 ml) will cost a bit more expensive: from 380 to 480 rubles.

Advantages and disadvantages

The preparation is balanced, allows you to partially dissolve even the toughest plugs, does not cause skin irritation and is safe even with prolonged use, including in children with allergic and skin diseases. The drops can be used both for prevention and for dissolving wax plugs. The only contraindications are perforation of the eardrum, fluid loss from the external auditory canal, and ear pain. There may be occasional discomfort for a few minutes after the insertion of the drops, which then subsides.

A-tserumen (surfactant)

Rating: 4.8

Finally, there are drops based on a fundamentally different action: not on the influence of the solvent, but on the surface active substances. These are special molecules that reduce the density of the wax, reducing adhesion, or sticking to the walls of the external auditory canal. Surfactants then increase the moisture content of the plug, and cause it to dissolve.

One of the most popular and active agents for dissolving plugs is the drops or spray, A-Cerumen, produced by the French company Laboratoire Gilbert. In the fall of 2020, the cost of this drug will be approximately 440 rubles. For the spray, 40 ml, and 420 rbl. For the drops, packed in 2 ml plastic ampoules (5 units).

This is a triple-action medication, and consists of three surfactants that have the ability to reduce surface tension at the media interface. It is an amphoteric, anionic and nonionic surfactant. They dissolve the plug, and most importantly, they break the bond between it and the wall of the external auditory canal, reducing its adhesion, or ability to stick to the walls.

The drug is very convenient for both treatment and prevention, these drops are enough to drop twice a week. If there is a formed sulfur plug, then A-Cerumen drops can be dripped once or twice a day for 3 to 5 days. With this tactic of treatment with drops, the plug gradually dissolves, wax secretion is restored, there is no risk of complaints, auditory or vestibular disorders.

In order to use the drops, you need to turn your head to the left in the prone position for the right ear, and vice versa. Pressing once on the plastic ampoule bottle, pour half of the ampoule into the ear. You have to lie with your head turned for about 1 minute. After that the head is tilted to the opposite side and the remaining wax plug and droplet remnants flow out freely. You then need to wipe the ear with a cotton swab, and under no circumstances use cotton swabs.

To completely clean the external auditory canal, you can rinse it with plain water, or 0.9% table salt, you can also use seawater, which was mentioned above. To simply prevent the formation of wax plugs, you should use these drops twice a week.

A-Cerumen should not be used in cases of eardrum perforation, hypersensitivity to the drug components, in cases of exacerbation of otitis media, and children under 3 years of age. Also a contraindication is a tympanic membrane shunt and time since its removal of at least 6mes-1 year.

Advantages and disadvantages

A-Cerumen is well tolerated, patient adherence to treatment is high, since the drops are used simply, and does not require any other drugs. In addition, this remedy can be used for prophylaxis, such as if a person frequently uses hearing aids, or indoor headphones.