Got an earful of wax? Some of it is good for you.
Earwax, technically known as “cerumen” is a bodily production that is actually pretty useful- in small amounts, that is. It naturally cleans as it moves from the inner part of the canal outwards. It gathers dead skin cells, hair, and dirt along the way. In normal circumstances, excess wax finds its way out of the canal and into the ear opening naturally, and then it is washed away. It also protects the ear canal skin from irritation due to water, dust, foreign particles, and microorganisms. Tests have shown that earwax actually contains antifungal properties, and so if your ears don’t have enough earwax, they’re likely to feel itchy and uncomfortable. So, using ear swabs to clear earwax is unnecessary and not recommended.
Causes of earwax build up
Excessive wax production can be the result of an overproduction by your glands, oftentimes seen in the summer as you sweat more. Conditions such as narrowing ear canals, overgrowth of hair in the canals, hypothyroidism, and diabetes can also contribute to more wax production. Additionally, you are more likely to have wax buildup if you frequently use earphones or wear hearing aids. They can inadvertently prevent earwax from coming out of the ear canals naturally and cause blockages. Still, excess wax alone doesn’t lead to blockage. In fact, the most common cause of earwax blockage is at home removal, when cotton swabs, bobby pins, or other objects are used and inadvertently push wax deeper into the canal, creating a blockage, or impacted wax.
Risk Factors for Earwax Impaction
You may be at risk for excessive earwax or impaction of earwax if your ear canals are narrow or not fully formed, there is an overgrowth of hair in your ear canals, and/or there are exostosis (benign bony growths in the ear canals). These conditions prevent earwax from naturally migrating out of the canal through epithelial migration (the skin of the canal working its way out of the canal in a cleansing fashion to carry wax and debris out and away from the eardrum). Additional factors may include the presence of eczema (dry skin throughout the body and ear canals) which causes earwax to dry and harden, making it more difficult to work its way out, uncontrolled diabetes, and the presence of a blockage of the ear canals, such as hearing aids and earbuds.
Signs and symptoms of impacted wax
The appearance of earwax varies from light yellow to dark brown. Darker colors don’t necessarily indicate that there’s a blockage.
Signs of earwax buildup include:
- Sudden or partial hearing loss, which is usually temporary
- Tinnitus, which is a ringing or buzzing in the ear
- A feeling of fullness in the ear
- An earache
How is impacted wax diagnosed?
A visit to your primary care physician, audiologist, or ENT (Ear Nose Throat) physician is in order if you think you have ears with impacted wax. These professionals will look into your ears with an otoscope or magnification source and assess whether or not there is earwax present and whether it is partially or fully occluding (blocking) your ear canal(s). They may also assess whether or not there is an active ear infection or perforation of the eardrum. Depending on which state you live in, these professionals can remove the wax with instruments or irrigation, oftentimes using a magnification source. Sometimes, it is necessary to soften wax that has hardened with wax softeners or specific ear drops ahead of your appointment.
How is impacted earwax treated?
Very basic cleaning of the ear such as wiping around around the outside of the ear and the canal opening with a small washcloth.
Other home remedies such as ear drops, from a local pharmacy include:
- The use of hydrogen peroxide, a mild antiseptic
- Wax softening products, such as EarwaxMD or Debrox
- Baby oil, olive oil, or mineral oil
To use any of the above as ear drops, one should tilt the head so the affected ear faces upward, place two to three drops in it, wait for one to two minutes in this position, then tilt the head so that the liquid can drain out (and be absorbed by a towel or napkin). This may need to be repeated several times a week for one to two weeks to help the earwax soften and work its way out. It is helpful to use drops nightly before sleeping to allow the ear(s) to absorb the drops more readily.
How is earwax treated?
If home remedies are not bringing about results, you should seek professional care to remove the earwax. Never use a cotton swab, bobby pin, or sharp object to remove it yourself, as this can cause damage to further impact your ears and/or damage sensitive tissues in the ear (such as the eardrum).
A professional assessment of whether the earwax is partially or fully occluding the ear canal as well as the consistency of the earwax (hard or soft) can determine the course of treatment.
Ear drops may be recommended to soften earwax to allow for easier removal. These may be used days prior to the actual removal of the earwax if it is very hard and impacted, or up to minutes before/during the appointment. If you have a perforated eardrum or active ear infections, drops will not be recommended and should not be used. Please consult with a professional prior to use.
Ear Irrigation, or the procedure of applying high pressure flow of water into the ear canal to remove impacted wax, may be used, especially if there is a plug of wax present. In some offices, a high -pressure flow of water using a metal syringe is used to dislodge and remove earwax. Some risks using this method is difficulty controlling the pressure as well as the water temperature.
In our audiology office in Lawrenceville New Jersey, we use the Earigator, which is a machine that has a self-contained temperature control function. This consistently regulates the water temperature to match your body temperature so that caloric effects or unwanted sensations of vertigo (common side effects of other irrigation methods) are avoided. Earwax is irrigated quickly and comfortably through precision-level pressure control.
Earwax irrigation is not for everyone. If you have a perforated eardrum, a tube in the eardrum, a current or recurrent bout of otitis media (middle ear infection), cleft palate, and/or there is mucous discharge from the ear, irrigation may be contraindicated.
Microsuction or the use of instruments may be used if irrigation is not an option or is unsuccessful. Microsuction is the use of a small instrument to vacuum earwax out of your ear. Instruments such as curettes, spoons, and hooks may also be used to manually work earwax out of your ear (in conjunction with a lighted, magnified source (microscope) such as a loupe.
What are possible complications of impacted earwax?
Impacted earwax can cause hearing loss, the sensation of fullness of the ears, tinnitus, and sometimes vertigo (when it pushes against the walls of the ear canal and eardrum).
Can earwax be prevented?
Impacted earwax can be prevented by reducing the use of cotton swabs as well as other objects that may push wax further in the ear canal. The use of earwax softeners as well as medical management through professional wax removal can help keep impacted wax at bay, especially if it is a chronic problem. Contact your primary care physician, audiologist, and/or Ear-Nose-and-Throat specialist if you experience hearing loss related to impacted earwax.