What you need to know about earwax
Earwax lubricates, cleans, and protects the lining of the ear canal. It does this by repelling water, trapping dirt, and ensuring that insects, fungi, and bacteria do not get through the ear canal and harm the eardrum.
Earwax consists primarily of shed layers of skin.
- keratin: 60 percent
- saturated and unsaturated long-chain fatty acids, squalene, and alcohols: 12–20 percent
- cholesterol 6–9 percent
Earwax is slightly acidic, and it has antibacterial properties. Without earwax, the ear canal would become dry, waterlogged, and prone to infection.
However, when earwax accumulates or becomes hard, it can cause problems, including hearing loss.
Read on to find out more about earwax problems and how to manage them.
Symptoms of earwax problems
Earwax can be annoying when it builds up, but prodding can both make it worse and cause damage to the ear's sensitive tissues.
If too much earwax builds up and becomes hard, it can form a plug that blocks the ear. A blocked ear may be painful and can affect hearing.
An earwax blockage may cause the following symptoms:
- an earache
- an ear infection
- tinnitus, which is a ringing in the ear
- a feeling of fullness in the ear
- vertigo, or a sense of being unbalanced that can lead to dizziness and nausea
- a cough, due to pressure from the blockage stimulating a nerve in the ear
An excessive buildup of earwax is the reason behind many hearing-aid faults.
It is essential never to put anything in the ear when trying to clear earwax.
Placing cotton swabs and other objects in the ear can push the earwax further down into the canal and make the problem worse.
People who produce a lot of earwax are more likely to have an earwax blockage and impaction, which is where the wax gets pushed deep inside the ear canal.
Swimming can cause some people to produce excess earwax.
Hearing aids and earplugs prevent wax from falling out of the ear naturally, which leads to its accumulation inside the ear.The use of items to remove earwax or relieve itching can make the buildup worse.
Such items include:
- cotton swabs, or Q-tips
- bobby pins
- napkin corners
These items can push the wax deeper into the ear canal. They can also harm the sensitive tissues of the ear, possibly leading to permanent damage.
People should carry out any cleaning or removal of earwax under the supervision of a healthcare professional.
Some people are more likely than others to have earwax problems. People who tend to collect more earwax in their ears include:
- individuals whose ear canals are narrow or not fully formed
- people with very hairy ear canals
- people with osteomata, or benign bony growths, in the outer part of the ear canal
- those with certain skin conditions, such as eczema
- older people, because earwax tends to become drier and harder with age, which increases the risk of impaction
- people with recurring ear infections and impacted earwax
- individuals with lupus or Sjogren's syndrome
People with learning difficulties often have earwax problems, but the reason for this is unclear.
Impacted earwax often comes out after using ear drops for around 2 weeks.
One way to remove excess earwax at home is to wipe around the outside of the ear with a washcloth.
Alternatively, a pharmacist can offer advice about suitable over-the-counter (OTC) treatments.
People can also use the following solutions, which are usually also available from a pharmacy, as ear drops:
- hydrogen peroxide, a mild antiseptic that is useful for cleaning wounds
- baby oil, almond oil, or olive oil
- mineral oil
To use the ear drops, people should tilt their head so that the affected ear faces upward, place one or two drops in it, and wait for 1–2 minutes in this position. They should then tilt their head so that the ear faces down and allow any liquid to drain out.
If people do this twice a day, the earwax will usually come out within 2 weeks. It often tends to do this at night while a person is asleep.
People should never use a cotton swab or another item to try to extract earwax. Inserting objects into the ear canal can damage sensitive tissues in the ear and make the impaction worse.
If home remedies do not work, a doctor can help to remove earwax.
If home remedies do not work, people should seek medical advice rather than trying to remove the earwax themselves.
A doctor will use a medical instrument called an auriscope, or otoscope, to examine the ear. They will check for a buildup of earwax and determine whether or not it has become impacted.
Earwax usually falls out on its own. Treatment is only necessary if there is an earwax blockage that is causing pain or hearing loss. In these cases, a doctor is likely to remove the earwax.
There are several methods for this, including those below:
The doctor will prescribe or recommend ear drops to soften the wax and make it easier to remove. People should use ear drops at room temperature.
The wax will typically soften within a few days and gradually come out on its own.
A person with a perforated eardrum or an active ear infection should not use ear drops.
If ear drops do not work, the doctor may recommend a procedure known as irrigation.
The doctor will apply a high-pressure 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, which carried a slight risk of damage.
Now, there are electronic ear irrigators that squirt a carefully controlled flow of water into the ear canal at body temperature.
Pressure control keeps the initial pressure as low as possible. It may be necessary to hold the ear at different angles to ensure that the liquid reaches every part of the ear canal.
If the person has severely impacted earwax, the doctor may need to look inside the ear with an auriscope several times during the irrigation process.
Ear irrigation is not painful, but having water squirting into the ear may feel strange.
Sometimes a person may report additional symptoms, in which case the doctor may investigate further to check whether there is an infection.
If irrigation does not remove the wax, the individual may need to continue softening the earwax with drops and then repeat the irrigation. The doctor may put water in the ear for around 15 minutes before irrigating.
If this does not work, the doctor may suggest seeing an ear, nose, and throat (ENT) specialist.
When is irrigation not suitable?
Ear irrigation is not suitable for everyone in all circumstances. The procedure may be unsuitable if any of the following factors apply:
- The person has had ear surgery in the last 12 months.
- A child has a tympanostomy tube, also called a grommet, which is a small tube that doctors insert to allow ventilation of the middle ear.
- Another foreign body is blocking the ear canal.
- The person was born with a cleft palate.
- The individual has a perforated eardrum or has had one in the last 12 months.
- The person has or has recently had otitis media, which is an infection of the middle ear.
- There is a mucous discharge from the ear, which could indicate an undiagnosed perforation.
Anyone who has had any problems, such as severe vertigo or pain, following previous irrigation should not undergo this procedure again.
If irrigation is not an option or is unsuccessful, the doctor may recommend either microsuction or manual removal to clear the ear canal.
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 that doctors may use for this procedure include curettes, spoons, and hooks.
The doctor will also need to use a special microscope so that they can see what is happening.
If the individual still has hearing problems or tinnitus after earwax removal, they may require a hearing loss test to check for other issues.
The authors of an editorial on the American Academy of Audiology's website have expressed concern about an alternative therapy for earwax that is called ear candling, ear coning, or thermo-auricular therapy.
It involves putting a hollow cotton or linen tube into the ear, lighting the end of it, burning it for around 15 minutes, and then pulling it out.
In the stub of the candle, there will often be a substance that resembles earwax, but researchers have found no evidence to suggest that this procedure removes wax from the ear.
In fact, studies looking at this practice have shown that it removes no earwax at all. People who have tried it have also reported complications, such as burns, rupture of the eardrum, and candle wax or other blockages in the ear.
The authors of the editorial conclude, "Ear candling is not reasonable, rational, safe, or effective, and indeed, it should simply never be done."
The United States Food and Drug Administration (FDA) do not support ear candling and have not approved this procedure.
Impacted earwax can lead to ear infections if a person does not get treatment. Very rarely, the infection may spread to the base of the skull and cause meningitis or cranial paralysis.
Vertigo is also possible if the earwax pushes against the eardrum, or tympanic membrane. This symptom can cause nausea and a sensation of moving even when a person is staying still.
Use cotton buds only for the outer ear
Impacted earwax can be frustrating, but it is usually easy to resolve with home remedies or medical treatment.
People should first ask a pharmacist to recommend some ear drops. If these do not work, they should seek medical help.
It is vital never to put anything inside the ear, as doing this can make the problem worse and may cause permanent damage.
Only ever use cotton buds to clean the outer parts of the ear, and never prod or poke the inner parts.
If the problem does not go away, you should see a doctor.