Earwax

Why does the body produce earwax?

Cerumen or earwax is healthy in normal amounts and serves as a self-cleaning agent with protective, lubricating, and antibacterial properties.  The absence of earwax may result in dry, itchy ears.

Earwax is not formed in the deep part of the ear canal near the eardrum, but in the outer one-third of the ear canal.  When a patient has wax blockage against the eardrum, it is often because he has been probing the ear with such things as cotton-tipped applicators, bobby pins, or twisted napkin corners.  These objects only push the wax in deeper.

When should the ears be cleaned?

Under ideal circumstances, the ear canals should never have to be cleaned.  However, that isn’t always the case. The ears should be cleaned when enough earwax accumulates to cause symptoms or to prevent a needed assessment of the ear by your doctor.  This condition is called cerumen impaction, and may cause one or more of the following symptoms:

  • Earache, fullness in the ear, or a sensation the ear is plugged
  • Partial hearing loss, which may be progressive
  • Tinnitus, ringing, or noises in the ear
  • Itching, odor, or discharge
  • Coughing

What is the recommended method of ear cleaning?

To clean the ears, wash the external ear with a cloth, but do not insert anything into the ear canal.

Most cases of ear wax blockage respond to home treatments used to soften wax.  Patients can try placing a few drops of mineral oil, baby oil, glycerin, or commercial drops in the ear.  Detergent drops such as hydrogen peroxide or carbamide peroxide may also aid in the removal of wax.

Irrigation or ear syringing is commonly used for clearning and can be performed by a physician or at home using a commercially available irrigation kit.  Common solutions used for syringing include water and saline, which should be warmed to body temperature to prevent dizziness.  Ear syringing is most effective when water, saline, or wax dissolving drops are put in the ear canal 15-30 minutes before treatment.  Caution is advised to avoid having your ears irrigated if you have diabetes, a perforated eardrum, tube in the eardrum, or a weakened immune system.

Manual removal of earwax is also effective.  This is most often performed by an otolaryngologist using suction, special miniature instruments, and a microscope to magnify the ear canal.  Manual removal is preferred if your ear canal is narrow, the eardrum has a perforation or tube, other methods have failed, or if you have diabetes or a weakened immune system.

Why shouldn’t cotton swabs be used to clean earwax?

Wax blockage is one of the most common causes of hearing loss.  This is often caused by attempts to clean the ear with cotton swabs.  Most cleaning attempts merely push the wax deeper into the ear canal, causing a blockage.

The outer ear is the funnel-like part of the ear that can be seen on the side of the head, plus the ear canal (the hole which leads down to the eardrum).  The ear canal is shaped somewhat like an hourglass — narrowing part way down.  The skin of the outer part of the canal has special glands that produce earwax.  This was is supposed to trap dust and dirt particles to keep them from reaching the eardrum.  Usually the wax accumulates a bit, dries out, and then comes tumbling out of the ear, carrying dirt and dust with it.  Or it may slowly migrate to the outside where it can be wiped off.

Are ear candles an option for removing wax build up?

No, ear candles are not a safe option of wax removal as they may result in serious injury.  Some of the most common injuries are burns, obstruction of the ear canal with wax of the candle, or perforation of the membrane that separates the ear canal and the middle ear.

When should a doctor be consulted?

If the home treatments discussed are not satisfactory or if wax has accumulated so much that it blocks the ear canal (and hearing), a physician may prescribe eardrops designed to soften wax, or he may wash or vacuum it out.  Occasionally, an otolaryngologist may need to remove the wax using microscopic visualization.

If there is a possibility of a hole (perforation or puncture) in the eardrum, consult a physician prior to trying any over-the-counter remedies.  Putting eardrops or other products in the ear with the presence of an eardrum perforation may cause pain or infection.

What can I do to prevent excessive earwax?

There are no proven ways to prevent cerumen impaction, but do not insert cotton-tipped swabs or other objects in the ear canal.  If you are prone to repeated wax or use hearing aids, consider seeing your doctor every 6-12 months for a checkup and routine preventive cleaning.

2010 American Academy of Otolaryngology – Head and Neck Surgery
For more information, visit entnet.org or consult with your ENT physician.