Ear Wax: What is it and How Do I Get Rid of It?

The number one reason why people suffer from conductive hearing loss is chronic ear wax build-up or impaction. Luckily, this can often be avoided or even removed at home without a trip to a health care professional, but care must be taken to avoid injuring the ear.

Overview:

• What is ear wax?
• What is the main cause of ear wax?
• What are the symptoms to recognise ear wax build-up?
• How can I get ear wax out of my ear at home?
• When is it necessary to see a doctor?
• What will a doctor do?
• How can I prevent excessive ear wax in the future?

What is ear wax?

Ear wax, or cerumen, is a natural substance produced in the ear canal. Often misunderstood, cerumen is an essential component of ear health, playing a crucial role in maintaining hygiene and function of the auditory or hearing system. It serves multiple purposes, including lubrication, protection and cleaning of the ear canal. Contrary to the common belief that ear wax is simply an unwanted by-product, recent studies underline its protective functions and the vital role it plays in the prevention of various problems related to the ear.

The ear acts as a natural barrier against dust, debris and microorganisms and bugs, and prevents them from causing damage to the delicate ear structures. This natural defense mechanism guarantees that the ear canal remains free from irritants and infections, indicating that while the ear wax can have a disordered appearance, it is essential for the health of the ear.

The composition of the cerumen is mainly a mixture of secretions from the sebaceous/oil and sweat glands, together with the shedding of skin cells. Its consistency can vary from person to person, influenced by genetic factors, environmental conditions and even diet. Contrary to popular belief, the presence of ear wax should not be seen as unpleasant, but rather as a sign of a working and healthy ear canal. Clinical tests suggest that the ear wax can have various colors and consistencies, from light yellow to dark brown and dry to wet - each potentially reflecting individual health and hygiene.

What is the main cause of ear wax?

Several factors could be the reason for excessive cerumen build up:

Genetics: A key factor that contributes to the accumulation of wax for ears is genetics. The research indicates that individuals with more active sebaceous/oil glands can produce greater quantities of ear wax (Naples, 2022). Genetic predisposition can influence not only the volume of wax produced, but also, its consistency, which varies between soft and hard types. The latter type is generally associated with a block risk due to its most solid nature and reduced ease of natural expulsion out of the ear canal.

Environmental influences also play a significant role. Regular exposure to powder and dirt can lead to an increase in the ear wax production while the body tries to protect the internal mechanisms of the ear from external particles. Houses that have high levels of pollen or pollution could contribute to increased cerumen production. In addition, people who participate in activities such as swimming or are frequently exposed to water may note an increase in ear wax while the body responds to the imbalance of humidity within the ear canal (Pierre & Tolisano, 2023).

Hygiene practices are another critical factor in the accumulation of wax for ears. Contrary to popular belief, excessive cleaning or the use of cotton swabs or Q-tips can push the ear wax deeper into the ear canal, causing a blockage. According to Gammoh et al. (2024), a significant percentage of individuals, about 23%, reported having attempted domestic remedies or using cotton swabs to manage ear wax, with unintentional consequences. Although hygiene is crucial, it is essential to approach the cleaning of the ear with caution to avoid creating more problems.

Personal audio devices: In recent years, the issues relating to the ears have been closely linked to the increase in the use of personal audio devices, such as earphones. A study by Flowers & Pillay (2021) highlighted that people who frequently use these devices can experience an increase in the accumulation of wax in ears due to the way the earphones can trap humidity and create a warm and dark environment, ideal conditions for the production of cerumen. Their results suggest that users of in-ear devices should regularly monitor their wax levels to mitigate potential complications.

What are the symptoms to recognise ear wax build-up?

There are degrees of discomfort that may be felt with ear wax build-up or blockage and it can be as variable as the amount of wax built-up and the length of time it has been building. Some symptoms that accompany an ear wax build-up include:

• Earache or pain in the ear or neck
• Sensation of fullness in the ear canal
• Tinnitus or ringing in the ear
• Hearing loss or noises sound like they’re being heard while underwater
• In young children, it can cause them to stick their finger or an object in the ear out of frustration or agitation. It’s best to have this treated by a healthcare provider to avoid causing damage to the delicate ear of a child.

• Ear wax build-up and blockage is the single greatest cause of conductive hearing loss and can be made worse by the use of hearing aids which block the ability for the ear to self-clean.

The most common manifestation of excessive accumulation of ear wax is auditory disability or loss of hearing. When wax hardens or accumulates in excess, it can obstruct sound transmission, creating a feeling of fullness in the ear and dulling hearing perception. A study by Pierre and Tolisano (2023) underlines the relationship between excessive ear wax and conditions such as swimmers ear or external otitis, a painful inflammation of the external ear channel. The investigation said: "The presence of excessive cerumen can create a humid environment that fosters bacterial growth, thus increasing the risk of developing external otitis, particularly after exposure to water." These findings indicate a direct link between reduced ears hygiene and subsequent infections.

If you’re experiencing severe pain, drainage or an unusual odor coming from your ear, it’s important to seek medical attention immediately. Your ear may be infected and must be treated by a health care professional to avoid further infection or permanent hearing loss.

How can I get earwax out of my ear at home?

Recent studies are exploring home remedies that have been historically popular to healthy management of ear waxes. For example, the application of some drops of warm olive oil or mineral oil can effectively soften the ear wax, making it easier for the body to eliminate naturally, without the risks associated with invasive cleaning methods, including the use of cotton swabs or Q-tips or other tools. A study published in the Journal of Otolaryngology-Head and Neck Surgery (Naples, 2022) observed that the participants who use this method have reported significant improvement and satisfaction, with minimal adverse effects. The importance of patience with these domestic remedies, affirming: "While it is tempting to aggressively remove the wax in the ear, the body has its mechanisms to manage this; the delicate methods they are always recommended ".

That being said, a recent analysis published in this journal reflects a growing concern among health professionals regarding the cleaning habits of self-diagnosed ears. Many people commonly resort to home remedies, believing that they can handle ear wax effectively without professional guidance. Pierre and Tolisano (2023) highlight that inappropriate cleaning methods can exacerbate the blockage and introduce pathogens into the auditory channel. The study warns that, although ear wax helps catch waste and microorganisms, excessive elimination can compromise the natural barrier of the ear.

It is essential to mitigate the risks of excessive ear wax ear and support the health of the ear, to maintain optimal ear hygiene. This includes periodic professional evaluations, particularly for people prone to the accumulation of ear wax. Routine ear exams allow safe removal of excessive wax, reducing the possibilities of infections such as swimmer's ear and avoiding possible long-term hearing problems.

A good rule of thumb for the general population is that only part of the ear that should be cleaned at home is the external part of the ear also known as the pinna. The ear is self-cleaning, and having some wax in the ear canal is healthy and also needed to protect the inner ear. Therefore, in case of ear wax build-up it is in your best interest to visit a Hearing Care Professional to guarantee the safety and integrity of the ear, particularly for people with a history of wax impaction or ear infections.

The Hearing Care Professional will assess whether or not removal is necessary. If for any reason the consistency is too hard and the wax cannot be removed, the client will be advised to use a few drops of mineral oil daily for one week before the Hearing Care Professional can safely remove it.

When is it necessary to see a doctor?

Despite its protective benefits, an excessive accumulation of auricular wax can lead to complications such as hearing loss, discomfort and, in some cases, tinnitus (ringing/buzzing in the ear). According to a study published in the Journal of Otolaryngology, about 6% of the population experience problems with the accumulation of wax in the ears, often due to the excessive use of cotton swabs or improper cleaning methods that can push wax more deeply in the ear canal instead of removing it. "The irony is that many people try to clean their ears too frequently, which can lead to the opposite effect of what they mean", underlines Dr. Naples.

It is important that people find a balance when it comes to the management of ear waxes. The maintenance of a certain level of cerumen is beneficial, as it protects the ear from various pathogens. Recognising the signs of an excessive accumulation of wax, such as reduced hearing or a feeling of fullness in the ear, can be fundamental to tackle the health of the ear in a proactive way.

If you are experiencing significant pain or hearing loss, you may have an infection or something more serious going on that requires professional intervention. In that case, you should see a health care professional to fully resolve the issue. In the case of a hearing loss being diagnosed even after the wax has been removed, a hearing care professional will be able to prescribe the most appropriate hearing aid to improve your hearing and quality of life.

What will the doctor do?

Clinically, the impact of cerumen can be resolved through different methods.

The specialists of the ear, nose and throat (ENT) often perform manual extractions using specialised tools such as syringing or suction. In a study conducted by Yang et al. (2016), the economic implications of the cerumen extraction procedures were examined. The researchers found that although the costs associated with professional extraction services can be substantial, they are often justified by the completeness and safety of the approach.

Contrary to various traditional home methods, in particular those based on candles for the ears or domestic tools, the professional extraction minimises the risk of complications such as the perforation of the tympanic membrane/ eardrum or the lesions of the skin lining the ear canal.

How can I prevent excessive ear wax in the future?

• Avoid Q-tips: Health-conscious readers should consider the adoption of proper habits to clean their ears. The ear is self-cleaning and often intervention is unnecessary. Manual cotton swabbing with Q-tips can push the wax more deeply to the channel, leading to complications. Thus, it is recommended to avoid insertion of objects into the ear canal as it can disrupt the natural wax removal process.
• Practice good hygiene: Practicing good hygiene and protecting ears against irritants should also be part of preventive measures. This includes keeping ears dry and avoiding exposure to excessive dust, water or humidity - conditions that may promote ear infections or exacerbate wax accumulation. In particular, swimmers can benefit from the use of swim plugs to prevent water from compromising the health of the ears.
• Regular check-ups with a healthcare professional are imperative especially for those who have a history of wax accumulation or other ear-related problems. Consulting a medical care provider not only helps to evaluate the health of your ears but also ensures that you receive personalised advice adapted to your unique anatomy. This professional guidance promotes a proactive approach to caring for the ear and reinforces the importance of individual health awareness.
• Natural solutions and preventive measures can effectively maintain the health of the ear, attenuating problems commonly associated with excessive wax. By adopting these strategies and remaining proactive in ear care, you can improve your hearing hygiene throughout your life. If you have hearing aids, then be sure to routinely clean your ears to prevent ear wax build-up or blockage.

Your ear health is important and removing excess ear wax can make improvements to your hearing and your overall health and wellbeing.

We’re here to help so if you have questions about improving or maintaining ear health for you or someone in your family, book an appointment with our team today!

References:

Naples, J. G. (2022). Understanding ear wax (cerumen) and ear cleanings. JAMA Otolaryngology–Head & Neck Surgery, 148(4), 388-388.

Pierre, J. J., & Tolisano, A. M. (2023). What is swimmer’s ear? JAMA Otolaryngology–Head & Neck Surgery, 149(7), 652-652.

Flowers, A., & Pillay, D. (2021). Sports audiology: Ear hygiene practices of gym users who wear earphones. South African Journal of Communication Disorders, 68(1), 1-7.

Yang, E. L., Macy, T. M., Wang, K. H., & Durr, M. L. (2016). Economic and demographic characteristics of cerumen extraction claims to medicare. JAMA Otolaryngology–Head & Neck Surgery, 142(2), 157-161.