Ear wax: What you need to know
Sticking any object in your ear, including cotton swabs, can lead to impacted ear wax and ear canal injury
When was the last time you thought about earwax? Last month? Last year? Maybe you’ve never really thought about it, beyond knowing it’s there: that yellowish, sticky substance we find on the cotton swab after cleaning our ears. We know earwax serves a purpose, but we might be a little fuzzy on the details. Then again, there’s no reason to spend too much time pondering this mild, mostly unseen body secretion, is there?
There is. Because while earwax plays an important role in overall ear health, too much of it can be a bad – even dangerous -- thing. Impacted earwax, the term for when too much earwax builds in the ear canal, can result in serious medical issues, including permanent hearing loss. And people who are older or wear hearing aids are at a significantly higher risk of developing impacted earwax.
What is earwax, anyway?
Earwax (clinical name cerumen) is an oily, waxy discharge secreted by tiny sebaceous and sweat glands in the outer part of the ear canal. While it might look dirty, earwax serves as a cleanser and creates a barrier to protect the ear canal against injury, infection, water, and foreign objects. Earwax also has a slightly acidic composition, which repels fungus and bacteria that would otherwise be attracted to the dark, moist atmosphere of the inner ear. Researchers have found several antimicrobial peptides in ear wax which, when combined, increase their strength and effectiveness.
While earwax is designed to coat the ear canal, it was not intended to stay there. As skin cells inside the ear grow and shift, the earwax travels with them through the ear canal, picking up dead skin cells, hairs, and other particles along the way. (Think of it as the ear’s natural trash collector.) The cycle of motion is further assisted by jaw movements that occur while we’re talking or chewing. As old earwax and debris moves out of the ear canal and flakes off, new earwax moves in to begin the process anew. (Fun fact: the smell of earwax also repels small insects who attempt to fly or crawl into the ear. If an insect does enter the ear canal, it will become caught in the earwax and expelled from the ear along with other unwanted particles.)
In most cases of impacted earwax, medical assistance is strongly advised regardless of severity. Earwax removal is always performed most safely and easily in a clinical setting. The most common techniques used by doctors are scraping or scooping the wax from the ear with special tools or using an irrigation device (such as a bulb syringe or warm water from a water pic) to soften the earwax and flush it out.
So, why can’t we use similar tools to clean our own years? For a few reasons. First, it goes without saying that we cannot see inside our own ears. To properly diagnose and treat ear issues, a medical physician must be able to look inside the ear canal to determine if earwax is impacted, or if there is an injury or infection before the proper treatment can be prescribed.
There are a few common instruments doctors may use to examine your ears in a clinical setting.
Otoscope
Also known as an auriscope, the otoscope is the familiar tool doctors use during check-ups to examine the outer and middle portions of the ear. It can be used to diagnose wax buildup, infection, injury, and other issues. This tool is especially useful for young children, infants, and others who cannot always articulate the symptoms they are experiencing.
Curette
A curette is a long and thin instrument with a tiny scoop on the end. It is used to scoop impacted or excessive ear wax from the ear canal. This tool should only be used by a trained medical professional in a clinical setting.
Irrigator
In some cases, irrigation with an ear wax softening solution can be useful to flush out wax buildup from the ears. This method can sometimes be used safely at home, providing there is no damage to the eardrum or existing ear infection. In cases where the eardrum is damaged or perforated, irrigation can be dangerous.
While irrigation can be and sometimes is performed at home, doctors have stronger irrigation equipment that can allow for a better result with fewer risks of complications.
Is it safe to remove earwax myself?
Treating your earwax at home can be difficult – and dangerous. You can’t see inside your ear, nor do you have the specialized tools or training to properly execute ear wax removal procedures. Even irrigation therapies can be dangerous if used improperly, as residual or trapped water can create a moist environment in the ear that sets the stage for infection.
“Sometimes what seems like earwax is actually debris from a condition requiring treatment, and sometimes earwax can cause dysfunction of your hearing devices,” said Danica Billingsly, Assistant Professor of Audiology at Northern Illinois University “It's impossible for you to tell from the outside what is happening on the inside -- even with a camera and light, you do not have the knowledge to recognize normal vs. abnormal.”
While some over-the-counter treatment options can be useful in cases of mild wax build-up, home suction devices are usually not recommended. Most doctors also advise against the use of ear candles, which can be dangerous and ineffective. If you are experiencing symptoms such as bleeding, drainage, or pain in your ears do not attempt home remedies unless directed by your healthcare physician. There may be a more serious problem that needs to be diagnosed.
Unless your provider has given you instructions in self-care they believe to be safe at home for your particular case, you should see your audiologist, ENT, or primary care physician,” Dr. Billingsly said.
Why does earwax get impacted?
When instead of flowing through and out of the ear canal, the earwax gets stuck there and continues to build, it becomes impacted. Ears are designed to clean themselves. Yet, impacted earwax is a very common issue and is linked to several causes including excessive earwax secretion, age, foreign objects in the ear canal, and a variety of health issues. For a deeper dive into these potential causes, click HERE.
The reasons for impacted earwax can be traced to several causes, including:
Putting foreign objects into the ear canal
It can be tempting to “clean” the ear by sticking a cotton swab or other object directly into the ear canal, but the risk outweighs the reward. While our dirty cotton swab might tell us we’ve successfully removed the earwax, what we’re seeing is more likely residue from the sides of the ear canal. Meanwhile, the impacted earwax was probably pushed even deeper into the ear, making the problem worse. (Remember, earwax is created in the outer ear, so impacted earwax near the eardrum is usually the result of failed cleaning attempts.) Placing objects inside the ear also increases the risk of ear infection or of damaging the eardrum. Even devices meant to be worn in the ear, such as swimming plugs, earbuds, or hearing aids, increase the risk of impacted earwax.
Age and health issues
As we age, the consistency of our earwax hardens and flows less easily through the ear canal, which can lead to wax buildup. One study found 35 percent of hospitalized patients over age 65 suffered from impacted earwax and 75 percent demonstrated improved hearing after it was removed. Some patients also reported improved balance after undergoing earwax removal, which may help reduce the risk of falls – a leading cause of hospitalization in older people. Health issues can also be a contributing factor to impacted earwax, particularly diabetes, eczema, a narrow ear canal, excessive ear hair, lupus, or cognitive disabilities. Diet, hygiene, and stress can also affect ear wax production.
What are the symptoms of impacted earwax?
Often, impacted earwax has no symptoms, or the symptoms are so common, such as intermittent coughing or an earache, they are mistaken for a head cold. Many people only discover they have impacted earwax when their physician checks their ears as part of a routine check-up or other, unrelated visit.
But there are signs and symptoms to be aware of, especially if you are prone to developing impacted earwax.
A sensation of fullness in the ear
Pain or itching in the ear
Dizziness
Discharge or odor from the ear.
Tinnitus, or ringing in the ear
Unexplained coughing
Hearing loss, which may increase over time
Hearing loss and impacted earwax
Impacted earwax is the most common cause of conductive hearing loss. The reasons are obvious: if there’s a blockage or barrier in the ear canal, sound will not be able to carry through as easily. If you suffer from impacted earwax, sounds and voices may become muffled, diminished, or hard to make out. In most cases, the hearing loss is temporary, and removing the excess earwax resolves the issue. But if impacted earwax is left in the canal for too long, it can lead to lasting damage to the inner ear and, in some cases, permanent hearing loss.
The differences in hearing post-earwax removal can be striking. Some experts estimate it can improve hearing by as many as 10 decibels.
Earwax and hearing aids
Placing a hearing aid, or any object, in the ear for an extended period prevents the normal flow of earwax, thus increasing the risk of buildup. Blocking the ear entrance with a hearing aid may also stimulate glands in the ear canal to produce even more ear wax, potentially worsening the issue. And the longer earwax sits in the ear canal, the harder it becomes and the more difficult it is to remove.
Many people report experiencing an increase in ear wax after wearing hearing aids. But the damage is a two-way street: earwax is one of the leading causes of hearing aid repairs. The acidic properties in earwax degrade the hearing aid’s electrical components over time and clog up vents and receivers.
If you wear a cochlear implant, it is not unusual to find earwax on the earmold. But a buildup of earwax on the implant can cause significant damage, ranging from feedback issues, reduced sound, improper fit, or increased hearing loss. Because hearing aids and implants block the ear from completing its natural cleaning process, hearing aid users should be checked for impacted earwax on a regular basis.
The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends that people who wear hearing aids have their ears checked every three to six months. This can easily be done by a primary care physician as part of a regular examination and does not require an ear nose and throat specialist. Daily cleaning of hearing aids is necessary to prevent damage caused by earwax. Wax traps should also be replaced every three months or as otherwise directed.
Treatment Options
Depending on age, symptoms, and severity, impacted earwax can be treated in several different ways. Sometimes no treatment is necessary, and the problem goes away naturally. Or a doctor might not treat impacted earwax if the risk of removing it is greater than simply letting it resolve on its own.
How can I prevent impacted earwax?
Depending on the underlying reasons or conditions causing your earwax buildup, there may be safe preventative measures you can take. Your doctor may prescribe regular ear cleanings every six months, or gentle, daily cleansing around the outer ear to create a clearer path for earwax to migrate out of the ear canal.
Some studies have found that consuming omega 3 fatty acids (found in fish, walnuts, and flaxseed) can reduce ear wax buildup.
Using a softening agent, such as a few drops of baby oil or mineral oil, can also help to discharge earwax from the ear. Over-the-counter earwax removal kits are sometimes recommended for mild cases of earwax. Always consult with your primary care physician before embarking on any preventative or home remedy treatment.