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Earwax blockage - earwax (cerumen)

The Ear Wax FAQ

Douglas Hoffman, M.D., Ph.D., December 1998

Disclaimer: This information is meant to improve the interaction between you and your doctor. It is NOT meant to replace this interaction! There is no substitute for a history and physical examination administered by a competent physician. If you inappropriately use this information to treat yourself, you may be endangering your health.

What is this stuff, anyway?

Ear wax is a sticky liquid secreted by cerumen glands. It isn't really wax in the 'candle wax' sense (paraffin). Skin contains many tiny glands whose sole purpose is to secrete a variety of substances. Sebaceous glands, for example, secrete sebum, which gives skin its greasy quality. Sweat is also produced by microscopic glands. Cerumen glands are found only in the skin of the ear canals.

What good is it?

Ear wax, sticky stuff that it is, traps anything foreign that flies, crawls, or is blown into the ear canals. Dirt, tiny bits of plant material, small insects, bacteria, and so forth are immobilized by wax. Think of wax as the sticky stuff on a No Pest Strip. The primary purpose of ear wax is to protect your ear canal and ear drum from such foreign materials.

What problems can ear wax cause?

Ear wax can cause hearing loss, pain, and cough. Hearing loss occurs when wax completely blocks the ear canal. This prevents sound waves from easily reaching the ear drum, in exactly the same way that ear plugs (or a strategically-positioned finger) block sound. Even a small amount of wax, if wedged between the ear drum and the ear canal wall, reduces the ability of the ear drum to conduct sound. Some people form very hard wax, which can cause pain by putting pressure on sensitive ear canal walls. Finally, since the ear canal shares some of the same nerves which give sensation to the throat, ear wax can provoke a "tickle in the throat" which can then lead to cough.

Why am I having this problem NOW?

While some folks have problems with ear wax throughout their lives, many people develop "problem wax" suddenly, without any obvious explanation. Similarly, a person may have wax problems with one ear and not the other. Ear surgery can occasionally result in the new onset of ear wax problems.

Usually, there is no answer to the question, "why is this happening now?"

How should I clean my ears?

Everyone has heard the ridiculous commandment, "Never stick anything in your ears smaller than your elbow." This may have been funny the first time, but now it's about as fresh as "Why did the chicken cross the road?" In fact, ear swabs are safe if used correctly. It is certainly safe to swab the outer portion of the ear. The opening of the ear canal can also safely be swabbed.

Deeper swabbing is potentially risky for three reasons. First, if you have a lot of ear wax, placing the swab into the canal will tend to pack it down, which can turn a partial blockage into a complete blockage. Second, you may damage the ear drum if the swab is inserted too deeply. Finally, if you scratch or abrade the ear canal skin, you may cause a painful infection of the canal ("swimmer's ear," known medically as otitis externa.) Despite these risks, if you do not have a lot of wax and are careful in your technique, you can swab more deeply in the canal.  But why would you want to do this? Wax migrates out of the canal all by itself and does not need your help. Remember, wax protects the ear canal skin and ear drum.

• Swimmer's ear

What should I do about problem wax?

People with a history of ear disease should go to an ENT for wax problems and not try treating the problem themselves.

• Most primary care physicians will attempt to remove wax by irrigation (squirting warm water into the ear canal to wash out the wax) or by scooping the wax out with a curette (a very small, metal ring at the end of a metal handle).  The curette technique can be very effective in skilled hands, but can be painful (and potentially damaging) in less-than-skilled hands. (Incidentally: removal of an impaction of hard wax is inevitably painful, regardless of technique.) Irrigation is always uncomfortable to some degree; some folks tolerate this better than others.

• Ear, nose, and throat (ENT) doctors usually remove wax by suction and/or curette techniques. This is typically done with the assistance of an operating microscope to give the doctor optimal visibility. ENT doctors have a variety of tools to remove wax, and will typically alter their methods depending on the hardness and location of the wax.

• Over the counter wax removal systems use irrigation with a solution containing hydrogen peroxide or a similar chemical, carbamyl peroxide. This can be effective, although hard wax and complete blockages often require more aggressive treatment (by a doctor!) Also, bear in mind that you run the risk of converting a partial blockage into a complete blockage by using peroxide, because the liquid can get trapped between the wax and the ear drum. This is true for any home remedy (see next dot).

• Some home remedies are safe and effective. A vinegar-water-peroxide solution (1:1:2) can be warmed to body temperature and applied to the ear canal to soften wax. A drop of baby oil can be placed in each ear canal on a regular basis (typically, once or twice per week) to soften hard, painful wax. People who have a history of middle ear infections, swimmer's ear, or a hole in the ear drum should NOT try these remedies, nor should they allow a physician to irrigate their ears, as such methods can lead to a painful and/or dangerous ear infection. As a rule, people with a history of any ear disease should go to an ENT for wax problems and not try treating the problem themselves.

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