Ear wax

What is ear wax?

Ear wax (or cerumen) is a mixture of several things, all naturally produced by your ear canal. These include dead skin cells and hair from the lining of the ear canal, sweat from sweat glands and a waxy substance known as ceruminous oil from the same named ceruminous glands. These mix together to form the golden yellow or greyish wax that you know.

 

Is wax important?

Yes! Many people consider ear wax as dirty or bad and something that should be removed where possible, but it is actually very important for the healthy functioning of the ear canal. It traps dirt and small insects and prevents them from getting into the ear. It prevents the ear canal from drying out and getting cracked, which can lead to infection. Ear wax is also acidic, which acts as a natural antibacterial agent against infections.

 

Is it okay to use cotton buds or Q-tips to clean wax from my ears?

No. The ear is a self-cleaning organ and wax moves out of the ear naturally during chewing and yawning. The use of cotton buds or Q-tips works against nature and serves to push wax deep into the ear canal where it can get impacted and harden, causing problems such as pain and hearing loss. This can happen regardless of how carefully you clean your ears with them. Cotton buds can also traumatise the delicate skin of the ear canal and, if pushed too deeply, can injure the ear drum or even the hearing bones (ossicles) within the middle ear.

 

There is a true saying that goes, “Nothing smaller than your elbow should go in your ear!” It is okay to clean the outside of your ears near the entrance (the bowl of the ear) with a damp towel.  

A short, educational YouTube video on the dangers of using cotton buds can be viewed here.

 

Why do I or my child produce so much wax?

Wax production, the type and the amount that is produced is hereditary. Many people are simply heavy wax producers by virtue of their genetic make-up. However, some factors may cause excessive wax production. Young children can often produce excess wax as a natural means of fighting protection when their immune system is still immature. The wax they produce may also actually be a normal amount ,but excessive in relation to the size of their smaller ear canals. As they grow older and the ear canal enlarges, this is often less of an issue. Skin conditions such as seborrheic dermatitis and eczema can lead to an overproduction of ceruminous oil or dead skin cells that can also cause more wax to accumulate.

 

What kinds of problems can excessive ear wax cause?

Most cases of excessive ear wax cause no problems, however they can occasionally block the ear canal and prevent sound waves from getting to the ear drum and thus cause deafness. As wax can swell in water, this can be problematic for swimmers when water gets in the ear. Swollen wax can sometimes cause ear pain. In hearing aid users, wax can cause problematic blockage of the ear mould.

 

What can be done for excessive wax?

If the ear wax is not bothersome, then is should be left alone. For problematic wax, there are several options:

  • Over the counter drops – these can be used to help break down the wax, such as olive oil, hydrogen peroxide or Otex. These can be used on an as needed basis. For a leaflet from Cambridge University Hospital on the best way to apply ear drops to the ear, click here.

  • Ear syringing – this is a very effective way of cleaning excessive wax with water or saline and can be done at your GP office. There is a risk of damage to the ear drum if improperly performed, which can lead to a perforated ear drum or tinnitus (ringing in the ears)

  • Microsuctioning – this is usually performed by an ENT surgeon or an ENT nurse practitioner, but audiologists can also sometimes perform it. The wax is suctioned out of the ear under direct microscopic vision and is the safest and most efficient way of clearing problematic wax. There is a small risk of minor injury to the ear canal and tinnitus due to the sometimes loud sound of the suctioning. This method requires you to lie fairly still and because of this, in younger children, it must sometimes be performed under a general anaesthetic.

There is currently no evidence that devices such as ear candles or Hopi candles work for excess wax and are not recommended. 

A patient having her ear microsuctioned for excessive wax.