It lubricates, cleans, and protects the lining of the ear canal by repelling water, trapping dirt, and making sure insects, fungi, and bacteria do not get through and harm the eardrum.
It is slightly acidic and has antibacterial properties. Without earwax, the ear canal would become extremely dry, waterlogged, and infected.
However, when earwax becomes hard or accumulates, it can cause problems.
Earwax consists mainly of shed layers of skin. It is 60 percent keratin, between 12 percent and 20 percent saturated and unsaturated long-chain fatty acids, squalene, and alcohols, and between 6 percent and 9 percent cholesterol.
Symptoms of earwax problems
Vertigo can be a sign of excessive earwax accumulation.
An excessive accumulation of earwax, especially when it is impacted, can lead to a blocked ear. A blocked ear can affect hearing and it may be painful. When the earwax build-up hardens and blocks the ear canal, it forms a plug, or blockage.
An ear that is blocked due to earwax may lead to:
- Ear infection
- Ringing in the ears, known as tinnitus
- A feeling of fullness in the ear
- Vertigo, which is a sensation of loss of balance
- Cough, due to nerve stimulation from the inside of the ear when pressure in the area is increased.
Most hearing-aid faults are believed to be caused by an excessive buildup of earwax.
Using Q-tips or another object to remove an earwax blockage can worsen the impaction.
Earwax blockage or impaction occurs more frequently in people who produce a lot of earwax. The wax gets pushed deep inside the ear canal.
The use of items such as Q-tips, bobby pins, keys, or napkin corners, to remove earwax or relieve itching in the ear can worsen the buildup. They can push the wax deeper into the ear canal.
Hearing aids and earplugs encourage wax to accumulate inside the ear, by preventing it from falling out naturally.
Swimming can cause some people to produce additional earwax.
Some people tend to collect more earwax in their ears, including:
- Individuals whose ear canals are narrow or not fully formed
- Patients with very hairy ear canals
- People with osteomata, or benign bony growths in the outer part of the ear canal
- People with certain skin conditions, such as eczema
- Older people, because earwax tends to become drier and harder with age, increasing the risk of impaction
- People with recurring ear infections and impacted earwax are more likely to accumulate earwax
- People with lupus or Sjogren's syndrome are more susceptible.
Some people with learning difficulties may have earwax problems, but the reason why is unknown.
Patients should seek medical help if they have a problem with earwax.
If an individual has earwax problems, they should not try to remove the earwax themselves, but seek medical advice.
A medical professional will examine the patient's ears using an auriscope, also known as an otoscope, to see if there is a buildup of earwax, and whether the earwax is impacted.
Earwax normally falls out on its own, and treatment is only necessary if the earwax is impacted and the patient has unpleasant symptoms of pain or hearing loss. In these cases, a doctor may need to remove it.
There are a number of ways to do this.
Eardrops can soften the wax, making it easier to remove. Eardrops should be used at room temperature. Within a few days, the wax will normally soften and gradually come out on its own.
Eardrops should not be used if a person has a perforated eardrum or an active ear infection.
If eardrops do not work, the doctor may recommend irrigation. Irrigation means washing the ear out by applying a pressurized flow of water to the ear canal to dislodge and remove the plug.
In the past, doctors used a metal syringe to irrigate the ear, and there was a slight risk of damage.
Now, there are electronic ear irrigators that squirt water, at body temperature, into the ear canal at a carefully controlled flow. Pressure control ensures that the initial pressure is as low as possible. The ear may be held at different angles to make sure the liquid reaches every part of the ear canal.
If the earwax is severely impacted, the doctor may look inside the ear with an auriscope several times during the irrigation process.
Ear irrigation is not painful, but it may feel strange to have water squirted into the ear.
Depending on the symptoms, the doctor may investigate further to check whether there is an infection.
If irrigation does not remove the wax, the patient may need to continue softening the earwax with drops and then repeat the irrigation. Water may be placed in the ear for around 15 minutes before irrigating.
If this does not work, the patient may be referred to an ear, nose, and throat (ENT) specialist.
When is irrigation not suitable?
In the following cases, ear irrigation might not be recommended:
- If the patient has undergone ear surgery in the last 12 months
- If a child has a tympanostomy tube, sometimes known as "grommets," a small tube that is inserted to allow ventilation of the middle ear
- If the ear canal is blocked with some other foreign body
- If the patient has, or has previously had, a cleft palate
- If the patient has a perforated eardrum, or has had one in the last 12 months
- If patient has, or has recently had, otitis externa, or a middle-ear infection
- If there is a mucus discharge from the ear, as this could indicate an undiagnosed perforation.
If a previous irrigation procedure was linked to problems, such as severe vertigo or pain, the patient should not undergo irrigation.
If irrigation is still unsuccessful, or not possible, the doctor may recommend either microsuction or manual removal.
Microsuction uses a small instrument to suck earwax out of the ear.
Manual removal may involve using a thin instrument with a small hoop at the end to clean the ear and scrape out any earwax.Other instruments used for this procedure include curettes, spoons, and hooks. A special microscope is also needed so that the doctor can see what is happening.
If a person still has hearing problems or tinnitus after earwax removal, a test for hearing loss may be carried out, to check for other problems.
Ear candling is not advised
Physicians have expressed concern about an alternative therapy for earwax known as "ear candling," "ear coning," or "thermo-auricular therapy."
It involves putting a hollow candle into the patient's ear, lighting the end of it, burning it for around 15 minutes, and then pulling out the candle.
In the stub of the candle, there will be a substance that looks like earwax, but there is no evidence that it is earwax.
Studies evaluating this practice have shown that it removes no earwax at all. Complications have been reported, including candle wax in the ear, burns, blockages of the ears, and rupture of the eardrum.
Ear infection can occur if the impacted earwax is not treated. Very rarely, the infection may spread to the base of the skull, causing meningitis or cranial paralysis.
Vertigo is possible if the earwax pushes against the eardrum, or tympanic membrane. This can cause nausea and a sensation of moving when a person is not moving.