EAR WAX

Ear wax cast removed from earA A cast of ear wax after removal.

Timothy C. Hain, MD

Last edited: 8/2002. Please read our disclaimer.

Ear Wax Defined Wax Problems Treatment Index

Ear wax defined

Ear wax is a normal product of the ear which protects the skin of the ear from water and infection. Ear wax is formed from wax glands in the external ear canal as well as other components such as dead skin, sweat, and oil. The primary component of ear wax is keratin (derived from dead skin). Ear wax thus differs slightly from cerumen which is the secretory product of the ceruminous glands in the external auditory canal (Hawke, 2002).

Different individuals vary considerably in the amount and consistency of their ear wax. There are two types described, wet and dry, which are inherited. Dry wax is common in Asia, while wet wax is common in western Europe. Dry wax, also known as "rice-bran wax", contains by weight about 20% lipid (fat). Oddly enough, rice-bran wax is associated with a lower incidence of breast cancer (Hawke, 2002).

Wet wax consists of approximately 50% lipid (Burkhart et al, 2000). Wet wax can be either soft or hard, the hard wax being more likely to be impacted. While ear wax is generally simply felt to be a nuisance, in medieval times, ear wax was used as a component of pigment for illumination of manuscripts (Petrakis, 2000). Too little ear wax increases the risk of infection (Fairey et al, 1985). Too much wax also increases the incidence of infection and hearing loss. So, you want just enough.

While we are not aware of a study of this, some people (and some ears) are "wax producers", and others remain wax free without much maintenence.

What can go wrong with ear wax ?

  1. Wax can plug up the ear, causing hearing to be reduced, and a full feeling in the ear
  2. Wax can trap bacteria in the ear, leading to infection. This is usually painful or at least itchy.
  3. Ear wax can obscure vision when the doctor looks in your ears, possibly hiding a dangerous process.
Otoscope (top) and Opthalmoscope with handle (bottom)

How does one know one has ear wax ?

Direct vision is the easiest way. An otoscope is used to visualize the wax.

How is ear wax treated ?

Problematic wax can be removed with drops, with water jets ("irrigation"), and with instruments by a doctor, audiologist or trained technician.

 

Ear wax removal under direct vision Wax removal under direct vision. A metal speculum (the trumpet shaped device) is placed in the ear canal. Wax is removed using an instrument called a "cerumen spoon", sometimes supplemented with gentle suction and forceps. Ordinarily this is done using an examining microscope (not shown), which provides magnification and a bright light.

The best way: removal under direct vision by a doctor or other professional is the best method of getting wax out, but it requires a doctors visit and the doctor must have access to a microscope. Practically speaking, this generally requires yearly visits to see a specialist called an "otologist".

Over the counter drops that help remove wax are largely basically water, oil and peroxide solutions (e.g. brand names are Debrox or Murine). Among the solutions are ordinary water, 10% sodium bicarbonate, 3% hydrogen peroxide, 2% acetic acid, and a combination of 0.5% aluminum acetate and .03% benzethonium chloride (Hawke, 2002). Hydrogen peroxide is present for the mechanical effect -- it does not dissolve ear wax (Burkhart et al, 2000). These preparations are best for those with small to moderate amounts of wax. Among oil-based organic solutions are olive oil, glycerin, propyline glycol, and others. Warming of solutions used for wax removal sometimes is helpful. According to Hawke, oil based preparations basically do nothing but lubricate (Hawke, 2002). Some preparations are enzyme based. We advise against use of "enzyme" based preparations, such as Cerumenex, because of problems with allergy. NONE OF THESE PREPARATIONS SHOULD BE USED IN PERSONS WHO HAVE A EARDRUM PERFORATION. In many patients, a wax plug blocks the ear so one cannot know for sure if a perforation is present. However in this situation, it is usually possible to make an educated guess with a reasonable degree of reliability (Hawke, 2002).

Irrigation or "syringing" is a standard method of wax removal and approximately 150,000 ears are irrigated each week in the United States (Grossan, 1998). While this is a conventional and accepted method of ear wax removal, it has many disadvantages compared to removal under direct vision. For example, in the rare instances when there is a perforation, irrigation may force water and wax into the middle ear, causing a nidus for infection.

Water jet devices such as used for dental care have also been used for ear wax removal. While generally effective, this method is judged unpleasant by many patients. There is also danger of perforation of the ear drum using these devices. Special tips can be used to reduce or eliminate this risk.

"Candling" is an "alternative" method of removing wax. This method is not felt to be effective.

Ear Wax Maintenance

First, one should realize that wax isn't all that bad. It keeps your ear dry and helps prevent infection. So, you don't want to eliminate wax, but just keep it from blocking your ear.

How can one keep wax from blocking the ear ? There are several methods.

One method is to put baby oil or olive oil into the ear on a regular basis. Put in the drops, let it sit in there for a few minutes, then lie down on a towel to let it drip out again. Probably only a few drops every week in each ear is good enough (nobody has done a research study on this). It doesn't hurt to put a few drops of clean olive oil or baby oil into each ear every day. Swimmers often do this prior to their daily swim. However, be sure that the oil is clean, as you don't want to introduce bacteria. This should not be done if you have an eardrum perforation or if you don't know whether or not you have a perforation.

Another method is to have your ear cleaned out by your doctor on a regular basis. Everyone builds up wax at their own rate, but commonly people need to come back for wax removal at 6 month or 1 year intervals.

 

When cotton tipped applicators are used to clean out ear wax, there is a risk of breaking the ear drum (perforation). Although we realize that this is commonly done, we recommend against using cotton tipped applicators, hair pins, and similar devices to clean the ear.

We recommend aginst using cotton tipped applicators (the so-called 'Q' TIPS) as well as putting other things into your ear such as hair pins. This can be dangerous because you run the risk of breaking your ear drum ("perforation"), as well as jamming wax deeper inside.

References:

Acknowledgements:

Graphics are courtesy of Northwestern University