Everything You Need to Know About Ear Wax

Ear wax, also called cerumen, is a substance that is formed from secretions of the glands (sebaceous and ceruminous) found in the ear canal. Secretions from these glands mix with sloughed off skin, normal skin bacteria, trapped water, and occasionally hair within the ear canal to form what we commonly call ear wax. Ear wax is a hydrophobic (repels water), protective substance. Based on your genetics, you may make two different types of ear wax:

• Wet – ear wax with a higher proportion of lipids found in Caucasian & African populations.
• Dry – ear wax with a lower proportion of lipids found in East Asian populations.

Ear wax has been shown to have protective benefits to the outer ear canal. Because earwax is hydrophobic it can protect the ear from the negative effects of trapped water. Ear wax also has potential antibacterial and antifungal properties and a healthy amount of ear wax may decrease your risk for ear infections like otitis externa and otitis media. However, despite its benefits, too much of a good thing can lead to problems.

Under normal circumstances, the body has a method of removing ear wax and sloughed skin through the movements of the jaw bone during activities like chewing or talking. Jaw movement causes the ear wax to move from your ear drum towards your outer ear. However, this system can break down and an accumulation of ear wax can occur. About 6 out of 100 people accumulate excess ear wax. However, the risk is higher in children, older adults, and people with cognitive impairments.

Other reasons for the excessive accumulation of ear wax include:

• Lack of ear wax and sloughed skin migration – can be the result of the normal aging process; can also be caused inappropriate ear wax removal methods
• Narrowing – can be affected by the shape of an individual's ear canal, soft tissue narrowing (from multiple and/or severe infections of the ear canal), or increased amounts of hair in the ear canal.
• Obstruction – bone (congenital or traumatic causes), skin sloughing, or soft tissue
• Overproduction – trauma, trapped water, and other unknown causes

Also, common objects used in the ears can also lead to an ear wax obstruction. Items such as hearing aids and ear plugs (noise reducing or for swimming) hinder the natural migration of ear wax.

Too much ear wax in the ear canal, or an ear wax blockage can cause the following symptoms:

• reflexive cough
• dizziness
• earache
• hearing loss
• feeling like your ears are “plugged”
• itchiness in the ear (can be a sign of infection or irritation)

Additionally, an inappropriate level of ear wax can be associated with the following conditions:

• Ceruminosis  –  too much ear wax in the elderly related to breakdown of the natural migration of earwax out of the ear canal
• Otitis externa – ear wax helps prevent common bacterial sources of swimmer’s ear
• Tinnitus (ringing in the ears)
• Vertigo

There are several methods that can be used to remove ear wax. However, if you have any of the symptoms described above you should consult a physician such as an otolaryngologist or an otologist. Some common methods for home removal can actually damage your ears or push the ear wax deeper into your ear canal. Methods to avoid include:

• ear candling
• Q-Tips or inserting other objects into your ear
• Cerumenolytics (solutions that break down ear wax or cerumen) - if you have damage to your tympanic membrane or surgically placed ventilation tubes

Ear wax should only be removed if you have symptoms or discomfort. The three recommended methods of ear wax removal by a trained professional include:

• Cerumenolytic agents
• Irrigation
• Manual removal – preferred method if performed by an otolaryngologist with expertise as it can reduce risk of damage to the ear canal or ear drum.

While removal of ear wax from a trained professional is relatively safe, rarely complications may occur including:

• allergic reactions (if cerumenolytic agents are used)
• otitis externa
• earache
• temporary hearing loss
• dizziness or vertigo
• ruptured ear drum
• ringing in the ear
• ear pain
• bleeding (usually mild)
• laceration

The following measures may help to prevent the accumulation of ear wax. However, you should consult your doctor before trying them, especially if you have a history of ear problems.

• dip a cotton ball in mineral oil, place in the outer ear canal 10 to 20 minutes per week
• avoid wearing ear plugs or hearing aids for 8 or more hours at night
• if you are predisposed to ear wax accumulation for medical reasons consider having a routine ear cleaning done by a healthcare professional every 6 to 12 months.