Why do I have earwax?

Ear wax, or “cerumen”, is a normal and helpful substance found in the ear canal that serves to clean and protect the ears. It is made by specific glands in the outer two-thirds of the ear canal but not in the inner one-third. It acts as a self-cleaning agent and has antibacterial properties. It is acidic which creates a poor environment for bacterial growth. It also contains enzymes and antibodies that can fight against bacteria. Cerumen is also able to catch dust, dirt and other unwanted substances before reaching the ear drum.

Why does wax build up in my ear?

The ear has a self-cleaning mechanism whereby wax is made and expelled from the ear canal daily. In addition to the natural movement of wax, chewing serves to assist the movement of wax out of the ear. Certain groups more commonly have wax build-up and include elderly people and those who wear hearing aids. However, anyone can have excess production of wax which can occur by genetics or repeated irritation. Sometimes, cerumen can be blocked from moving out of the ear canal. This can occur due to:

  • Abnormal anatomy of the ear canal
  • Excess hair in the ear
  • Blockage from hearing aids
  • Displacement into the inner one-third of the canal from Qtips/cotton swabs, finger manipulation or other instrumentation

It is important to know that cerumen is a normal and beneficial part of the ear. It does not always need removal and nothing needs to be done unless the build-up causes symptoms. Some common symptoms that can be seen with cerumen impaction are:

  • Ear fullness
  • Hearing loss
  • Ringing in the ear/Tinnitus
  • Itching
  • Ear pain
  • Change in hearing aid function

Always remember to see your primary care doctor or ENT if you have symptoms and are unsure if they are related to ear wax. There may be a separate problem that requires medical care.

What should I do about ear wax?

A primary care doctor or ENT should perform an ear exam with visualization of the ear canal (otoscopy) in order to diagnose a cerumen impaction.

If a cerumen impaction is diagnosed, there are multiple treatment options:

  1. Observation – Sometimes wax doesn’t pose a significant problem and over time it may resolve on its own.
  2. Irrigation – This is typically performed by a primary care provider or ENT though there are irrigation kits that can be purchased over-the-counter. This can sometimes resolve cerumen impactions but may cause pain or dizziness. It is important to avoid high pressure irrigation so as not to injure the ear canal or ear drum.
  3.  Cerumen Softening Agents – Include Debrox, sweet oil, mineral oil. Useful to soften wax when used daily so that self-cleaning mechanism can work more efficiently or make in-office removal easier.
  4.  In-office Removal – Cerumen is removed using suction or cleaning tools with or without the aid of a microscope. Typically performed by a licensed provider.

Some patients require regularly scheduled visits a few times per year to have cerumen removed. Others may only need removal once in a lifetime. The most important thing is to have your ears checked by your doctor if you notice symptoms of a wax impaction.

A Note on Qtips/Cotton Swabs..

Qtips/Cotton swab use should be avoided for ear issues altogether. There are multiple problems with this method. First, the swab may clean some of the wax at the outermost aspect of the ear canal but the rest will be pushed into the innermost area of the ear canal. When this happens, the ear cannot push it back out and it becomes impacted. Second, Qtips/cotton swabs can cause microtrauma to the thin ear canal skin and predispose to infection. Finally, Qtips/cotton swabs or any other instrument has the potential to cause damage to the ear drum or middle ear which can result in hearing loss, vertigo/dizziness or infection.