Earwax – a little gross, sometimes a little sticky, sometimes a little flaky, most of the time not something anyone wants to think about. We all have it though and like many of the mysterious processes and substances of the human body, earwax does, in fact, serve a purpose. For some individuals, excessive production and accumulation causes earwax to be seen as more of an embarrassing nuisance than a useful bodily secretion, a condition known as cerumen impaction, “cerumen” being the medical (and less yucky-sounding) term for earwax. Cerumen impaction can affect up to 6% of the general population with approximately 12 million patients seeking medical attention for earwax build-up every year in the US.
What is earwax made of?
Earwax, or cerumen, is formed in the external auditory canal, a section of the ear between the meatus of the auricle (the hole of the ear canal visible from the outside) and the tympanic membrane, or eardrum, farther inside the ear. The skin lining the external auditory canal contains hairs and associated sebaceous glands and as well as a type of sweat gland known as ceruminous glands, which contribute to the production of earwax. Cerumen has also been found to contain epithelial skin cells and keratin sloughed away from the routine turnover of the superficial layers of the skin of the ear canal, as well as dirt and dust that may have found their way into your ear.
Interestingly, there is some evidence of variations in earwax between different ethnicities, indicating a degree of genetic influence. Hopefully in your day-to-day life you don’t encounter too much earwax from ears other than your own, but if you do, you may have noticed that cerumen from Caucasian and African American ears tends to be of the sticky, wet variety, while the dry, flaky form of earwax is more common in Asians and Native Americans.
What is the role of earwax?
The production of earwax is thought to play a role in helping to keep the ear canal clean. Debris, dust, and dirt are trapped by cerumen, preventing them from traveling farther into the ear. Earwax is also is a way of removing the superficial epithelial layer of skin of the ear canal as it continually is renewed and shed away. Though not all studies have found evidence to support the antimicrobial properties of cerumen, it is generally accepted that there is some antibacterial and antifungal purpose of earwax.
Earwax is being constantly produced and moved to the opening of the ear canal by jaw movements such as chewing or talking, as well as the turnover of epithelium within the canal. It usually just takes a thorough shower or bath to wash away the old cerumen from the opening of the ear.
What to do with an earful of earwax
Cerumen impaction refers to a build-up of earwax. The accumulation of cerumen can partially or fully block the ear canal and may be a result of narrow anatomy, which causes the ear to be particularly prone to impaction, or irritation to the ear canal skin such as from hearing aids causing an excess in cerumen production and a hindrance to its normal route of removal. Certain dermatological conditions interfering with normal epithelial turnover can also lead to cerumen impaction.
Symptoms of earwax impaction include:
- Ear pain or itching
- The ear feeling full or blocked
- Hearing loss
- A discharge or odor from the ear canal
An interesting additional symptom of impaction is a reflexive cough as the earwax irritates a branch of the vagus nerve, a cranial nerve connecting multiple areas throughout the body including the throat. Patients who use hearing aids may also notice a deterioration in the function of their aids as the acidity of excessive cerumen can corrode the electronics or physically block the parts.
As a certain degree of earwax accumulation is quite normal and usually self-clears within a week without treatment, seeking medical assistance for removal is only necessary if you are symptomatic or if the eardrum needs to be examined but the view is blocked by cerumen. A doctor, whether general practitioner or otolaryngologist, may gently syringe water into the ear canal to flush out the blockage, though this technique is not recommended for patients with ear inflammation or infections, a history of ear surgery, or hearing impairment on one side as ear syringing has the potential to damage the eardrum or exacerbate tinnitus. An otolaryngologist may also offer cerumen impaction treatment by using microsuction or curettage, which involves using a special instrument to physically scoop earwax from the ear.
For home remedies to relieve cerumen impaction, the most commonly recommended method is the use of earwax softening drops, also known as cerumenolytics. Doctors strongly advise against using cotton-tips or other similar tools in an attempt to clean the ear canal as this usually only serves to push earwax farther into the canal. Imagine being a little blob of cerumen that has traveled all the way to the opening of the ear canal only to be shoved back down by a Q-tip! Very disheartening for the earwax blob and very counterproductive to removing cerumen impaction. Sticking foreign objects into the ear also has the potential to cause an ear infection or perforated eardrum. Ear candling is another popular treatment that doctors recommend staying away from as it is not considered to actually be effective in earwax removal and has the potential to cause ear infections or burns to the ear canal.
Some people are more earwaxy than others and so may need regular visits to an ENT specialist to have their ears cleaned or will need to routinely apply earwax softening drops at home. Those who wear hearing aids or ear plugs may find themselves in this category as these devices can irritate the ear canal and induce excessive cerumen accumulation. Regardless of whether you’re very earwaxy or just a little earwaxy, rest assured that earwax is quite normal and, for the most part, good for you.