The Wax We Packs

Today I will engage in a Q & A regarding the fascinating world of earwax. We in the audiology world call it "cerumen". Enjoy!

Q: What is cerumen?
A: Per Okuda et al.(1991): "Earwax is a mixture of desquamated keratinocytes and hair combined with the secretions of both the ceruminous and the sebaceous glands of the external ear canal... The major organic components of earwax identified were long chain fatty acids, both saturated and unsaturated, alcohols, squalene and cholesterol."

Layman's terms: the wax and oil producing glands within the skin of the outer 1/3 of the human ear canal put out secretions that mix with dead skin cells. It is made of saturated and unsaturated fats, alcohols, cholesterol, and a naturally existing moisturizer present in our skin. Additionally, it is hydrophobic which means that it repels water and other fluids.

Q: Is cerumen dirty?
A: Cerumen is like any other mucous in your body - it is present to protect. It keeps the skin in your ear canals moisturized and collects any foreign debris from entering too deeply into the ear canal. It also maintains a ph balance so that infections do not develop in the ear canal. It is there for a reason.

When there is an excess buildup of cerumen it may simply be due to overproductive ceruminous cells (I call these patients my wax factories) or because your ear is doing its job - it has caught a foreign substance and is building up more cerumen to surround it and expel it. Which leads to the next question...

Q: How do I clean my ears?
A: Your ears can clean themselves! There are tiny muscles and hairs in the outer 1/3 of our ear canal (which is also where the wax is produced). When enough cerumen is present, the muscles contract in an attempt to propel the substance outward. Have you ever felt a tickle in your ear and then reached up to find a small ball of wax in the bowl (concha)? That is the ear doing its job!

When wax has been pushed (usually via Q-tip/attempted cleaning but sometimes because there is an earplug or a hearing aid in there) some assistance may be needed.

In many cases letting some water go into the ear canal while bathing/showering may do the trick - just remember: let gravity help you! When water alone is not helpful you may try over-the-counter cerumenolytic drops which can soften or break down the cerumen so that it is easier to come out.
**SAFETY NOTICE: If you have tubes in your eardrums or a know perforation (hole) in your eardrum, or a history of chronic external ear infections please do NOT put any type of fluid into the ear canal!!!**
Hydrogen peroxide: I advise my patients against cleaning with hydrogen peroxide as it is chemically a base and may neutralize the acid balance in the ear canal necessary to ward off infections.

When these methods fail or are not possible, I strongly recommend that you seek professional attention.

Q: Sometimes my child has wax pouring out of their ears - can I wipe that up with a washcloth?
A: Yes. This is totally fine. If the wax is really wet, smells bad or has blood in it, please see your pediatrician. But some kids are just wax factories and migrating out of the canal is better than it getting packed in.

Q: What's wrong with Q-tips? They feel so good!
A: Q-tips have multiple downsides. Besides the fact that one slip can run it clear through your eardrum and into your middle ear space (I have seen permanent ossicular - ear bone - damage from this), there are other ways their use is problematic.

While those few seconds may feel like aural heaven, afterward you may notice that your ears are itching. So you grab another Q-tip. It eases the itch for a while but eventually it's back. Why is that? You removed the moisturizer then scratched up your dry ear canal with a swab of cotton. Have you ever just scratched a spot on your skin for a while and it turns red and irritated? Some thing. You are CAUSING your ears to itch BECAUSE you use Q-tips. So stop.

Unless you have very large ear canals (which are rare), your ear canals are only slightly wider than the end o fa Q-tip. So instead of pulling a chunk of wax out you can actually push it further back into your ear. Repeated packing can cause a full block in the ear canal and result in hearing loss that is (sorry) your fault. Also common is that some of the cotton on teh Q-tip can come off in the ear canal and your wax cells then go on hyperdrive trying to bundle it up and kick it out. This usually backfires.

ALSO Do NOT buy ear candling (it does NOT work!) or little curettage kits or those "magical" spiral thingies.

Q: OK, so how does a professional cleaning differ? Aren't you sticking things in my ears?
A: In my practice, I offer three types of cerumen management:

1) Irrigation: there are several devices that are used across the industry but I use a water-pik which a special tip that spreads the flow around the canal and not directly toward the eardrum. This is actually usually my method of last resort unless I know for sure that the patient is healthy and can visually confirm that there are no perforations of the eardrum. Irrigation is what is most commonly used in medical offices and facilities without audiologists or ENT's on staff, and often without knowledge of the status of the eardrum. It is possible that in these cases water can enter the middle ear space and cause serious infections.

2) Curettage/tools: many types of tools exist, usually a long stick with a circle, oval, or scoop on the end. There are lighted, stainless steel, and single-use plastic varieties. There are also tools that look like scissors with a little mouth on the end - alligator forceps. I LOVE these! When proper visibility is ensured (most commonly by headlamp or an otoscope) this can be successful but it can be high risk for very squirmy patients and/or those on blood thinners (or who naturally bleed easily, including diabetics). Which leads into my favorite method...

3) ... Suction! I love using suction. It often requires little contact with the ear canal itself which reduces risk of bleeding. It is great for really hard wax (antiques... my term, not technical) that would be painful to grab with tools.

I have a microscopic binocular LED-lit headlamp to make things visible. I use cold sterilization of my stainless steel tools. I wear gloves and utilize many layers of infection control. t is common that I use more than one method. Sometimes it works quickly, sometimes I'm going at it for 30 minutes and have to use cerumenolytics to help the process along. If I feel that it would be dangerous to attempt, I will not even try and will send them to an otolaryngologist.

Summary: TRUST A PROFESSIONAL!


Okuda I, Bingham B, Stoney P, Hawke M. The organic composition of earwax. J Otolaryngol. 1991;20(3):212–215.