Earwax (Cerumen Impaction)
Earwax, called cerumen, is produced by special wax-forming glands located in the skin of the outer one-third of the ear canal. It is normal to have cerumen in ear canal as this waxy substance serves as a self-cleaning agent with protective, lubricating, and antibacterial properties. The absence of earwax may result in dry, itchy ears. Self-cleaning means there is a slow and orderly movement of earwax and dead skin cells from the eardrum to the ear opening. Old earwax is constantly being transported, assisted by chewing and jaw motion, from the ear canal to the ear opening where, most of the time, it dries, flakes, and falls out.
What Are the Symptoms of an Earwax Blockage?
Symptoms of an earwax problem may include:
- Feeling of plugged hearing or fullness in the ear
- Partial hearing loss that gets worse
- Tinnitus, ringing, or noises in the ear
- Itching, odor, or discharge
What Causes Earwax Blockage?
When a patient has wax blockage against the eardrum, it is often because they have been probing the ear with such things as cotton-tipped swabs, bobby pins, or twisted napkin corners. These objects only push the wax in deeper in the ear canal.
Why Is It Dangerous to Use Swabs to Remove Earwax?
Wax blockage is one of the most common causes of hearing loss. This is often caused by attempts to clean the ear with cotton swabs. Most cleaning attempts merely push the wax deeper into the ear canal which is shaped like an hourglass, causing a blockage at the narrowing part of the ear canal. In addition, accidental trauma to the ear drum or ear bones can occur if the swab is pushed too deep.
Good intentions to keep ears clean may lessen the ability to hear. The ear is a delicate and complicated body part, including the skin of the ear canal and the eardrum. Therefore, special care should be given to this part of the body. Discontinue the habit of inserting cotton-tipped swabs or other objects into the ear canals.
What Are the Treatment Options?
Cleaning a working ear can be done by washing it with a soft cloth, but do not insert anything into the ear. Ideally, the ear canals should never have to be cleaned. However, that isn’t always the case. The ears should be cleaned when enough earwax gathers to cause symptoms or to prevent a needed assessment of the ear by your doctor. This condition is call cerumen impaction.
Most cases of ear wax blockage respond to home treatments used to soften wax. Patients can try placing a few drops of mineral oil, baby oil, glycerin, or commercial drops in the ear. Detergent drops such as hydrogen peroxide or carbamide peroxide (available in most pharmacies) may also 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 hole in the eardrum (perforation), tube in the eardrum, skin problems such as eczema in the ear canal or a weakened immune system.
Manual removal of earwax is also effective. This is most often performed by an ENT (ear, nose, and throat) specialist, or otolaryngologist, using suction or 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 skin problems affecting the ear canal, diabetes or a weakened immune system.
When Should I Talk to a Doctor?
If home treatments do not help, or if wax has accumulated so much that it blocks your ear canal and your ability to hear, an ENT specialist may prescribe eardrops designed to soften wax, or they may wash or vacuum it out. Your ENT specialist may also need to remove the wax under microscopic visualization.
If there is a possibility of a perforation in the eardrum, consult a physician prior to trying any over-the-counter remedies. Putting eardrops or other products in the ear with the presence of an eardrum perforation may cause pain or an infection. Washing water through such a hole could start an infection.
If you are prone to repeated wax impaction or use hearing aids, consider seeing your doctor every six to 12 months for a checkup and routine preventive cleaning.
What Questions Should I Ask My Doctor?
- What are the benefits and risks/side effects of different cerumen removal management options: earwax softening products, water irrigation vs. physical removal?
- Does cerumen accumulation vary with age, gender, familial or dietary intake?
- How do I manage swimming underwater with cerumen impaction?
- Should anything be done to the ears to prevent a buildup of earwax?
- How often should cerumen be removed from the ears?
- Are ear candles a safe option for removing earwax?
With permission of the American Academy of Otolaryngology–Head and Neck Surgery Foundation,
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