Ears & Hearing

Ear Wax

Earwax, or technically, cerumen, is a normal byproduct of the self-cleaning mechanism of your ear canal.  Earwax, in normal amounts, provides protection to the delicate skin of the canal, is lubricating and helps the skin from drying and flaking excessively, and is antibacterial to help prevent infection.  Normally, the ear is self-cleaning and wax works its way out without any human intervention (particularly Q-tips® or cotton swabs!!).  Movement of the jaw and chewing motion help with the normal migration of wax out of the ear and is washed away with normal hygiene.

Trying to manage earwax can result in several problems, not the least of which is impaction of wax since it is easier to push wax further into the ear than to get it out.  Wax pushed into the ear is even more difficult, and often more painful, to remove.  The ear canal is “S” shaped which helps prevent accidental injury to the eardrum.  In addition, the use of cotton swabs, hair pins, pens, or even your fingers can result in scratches in the thin skin that covers the cartilage and bone of the canal.  In turn, this is a common cause for outer ear infections.  The absence of earwax may also result in dry, itchy ears; in fact, flakes and skin slough from too little wax can be more difficult to manage than wax itself.

This is not to say that an excess of wax cannot occur.  Genetic, environmental, dermatalogical and immunological factors can lead to an excess of wax.  Too much wax can block the ear and decrease your ability to hear without restriction.  Fortunately, it does not actually cause hearing loss even though it can block the movement of sound waves from reaching the parts of your ear that are responsible for hearing.  In these cases, it may be necessary to manage the condition known as ceruminosis.

Although ideally the ear canals should never have to be cleaned, that isn’t always the case. The ears should be cleaned when enough earwax accumulates to cause symptoms including the following:

  • 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
  • Most cases of ear wax can be managed by softening or dissolving the wax and gently sponging it away with a moist face cloth. Patients can try placing a few drops of mineral oil, baby oil, glycerin, hydrogen peroxide or carbamide peroxide in the ear to aid in the removal of wax.

Irrigation or ear syringing is commonly used for cleaning 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 to 30 minutes before treatment. Caution is advised to avoid having your ears irrigated if you have diabetes, a ruptured eardrum, a tube in the eardrum, or a weakened immune system.

Manual removal of earwax is also effective but is best 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.

Lastly, ear candling is not recommended.  Injuries including burns, obstruction of the ear canal, and injury to the ear drum have been reported.  The U.S. Food and Drug Administration (FDA) became concerned about the safety issues with ear candles after receiving reports of patient injury caused by the ear candling procedure. There are no controlled studies or other scientific evidence that support the safety and effectiveness of these devices for any of the purported claims or intended uses as contained in the labeling.