Ear wax

What is ear wax?

Ear wax is a normal substance found in the ear canals. It is a combination of secretions from special glands near the hairs of the outer part of the ear canal (which are modified sweat glands) and flakes of skin which are shed from the ear canal with time. This clumps together to form the ear wax which we are all familiar with.

The ear wax will generally accumulate around the outer part of the ear canal and it traps dust and other material, preventing it from going further into the ear canal. Wax is not produced further inside the ear canal, and usually does not find its way down that far, but this can be an issue with cotton bud use.

Ear wax becomes darker brown with time as it oxidises in the air. Despite its appearance, is not dirty- it is simply an important natural product of the ear.

Different people make different amounts of ear wax, just like some people sweat more than others or have more dry or more greasy skin. People of different ethnic backgrounds also have different consistencies of wax. For example, Afro-Caribbean people tend to have quite moist wax, Asian people have drier, flakier wax and white people have a consistency of wax somewhere in between, but of course this varies.

People who use hearing aids, earphones and earplugs may find that these devices seem to make their ears more waxy- perhaps a combination of irritation of the wax producing glands of the outer ears, and also the wax being pressed into the ear canals.

What problems can ear wax cause?

In most people, ear wax causes no problems at all, and does not need to be treated in any way. The outer part of the ear can often look quite waxy, as parents will notice in their children’s ears. However, it is uncommon for this to be a medical problem.

In some people, the wax can accumulate and becomes impacted, blocking one or both ear canals. This can cause muffling of the hearing and discomfort. The wax can also be colonised with bacteria, giving a slightly cheesy, fishy smell. Even then, it is very unlikely that the wax will cause any harm to the ear.

In many cases, attempts to remove the wax at home (with over-use of drops or cotton buds [Q-tips]) can push the wax further into the ear and cause more problems than would have occurred if the wax was left alone.

How is wax removed?

Wax can be removed from the ear canals in a number of ways.

This is often tried at home using cotton buds, but these will sometimes push the wax further in, making it more impacted and uncomfortable. Cotton buds can also cause injury to the ear canals, causing bleeding or secondary infection. Even worse, they may also cause injury to the ear drums, occasionally resulting in a hole or even damage to the hearing. For these reasons, cotton buds should not be inserted into the ear canals.

Ear syringing, using a gentle jet of warm water from a special machine, may be used in GP practices to clean the ears. This can often be very effective.

In ENT practice, we tend to use a combination of different instruments, depending on the amount and consistency of the wax. This is done with the help of a microscope in clinic, allowing an excellent view as the wax is removed. Gentle suction of the wax with a little sucker (microsuction) is often effective if the wax is soft. For harder wax, a variety of metal instruments (probes) can be used to tease out the wax, while protecting the rest of the ear.

Is wax removal dangerous?

Removal of ear wax is done very gently, and it is usually well-tolerated, even in young children. We should remember that the ears, like the eyes, are very sensitive and delicate, so the procedure can feel intrusive and uncomfortable, even if it is performed gently.

In some cases, not all of the wax can be removed, because of discomfort. In these cases, wax softening drops may help, and patients can return for another visit when the wax is softer.

Sometimes the wax is dry and adheres to the ear canal skin. This means that as it is lifted off the skin, it can be raw and painful and may lead to a little bit of bleeding. Injury to the ear drum and the hearing mechanism of the ear are very rarely seen.

Do ear drops help? Which drops are the best and how do I use them?

A variety of wax softening drops can be used. These liquefy the wax and make it more gloopy, and also help tease wax off the ear canal skin. This can make removal of the wax much easier and less painful.

But the ear drops will not usually mechanically flush wax out of the ears. If there is quite a lot of wax in the ear canals, this is likely to remain the case, even with ear drops. But it will be softer and more easily removed.

Types of wax softening drops include sodium bicarbonate drops, urea hydrogen peroxide (Otex), propylene glygol (Cerumol), glycerin/ urea peroxide (Earex) and olive oil. Studies have shown similar effectiveness between the types of drops in terms of softening wax. But we should bear in mind that if the ear is infected, or if there is a hole in the ear drum, certain drops, especially olive oil, are likely to be the most gentle and to cause less irritation than some of the others.

Keep the ear drops at room temperature, and they can be warmed a little further under a warm tap before use. While lying on the side on a clean old towel, with the affected ear upwards, fill the ear canal with the drops and wiggle the ear lobe so that the drops find their way down the ear canal. Remain in this position for 10-15 minutes if possible, before turning the ear down onto the towel, to allow the drops and any waxy residues to drain out. If the wax is impacted, do this twice a day for two weeks before an appointment for wax removal. If there is any associated pain or discomfort, stop at once.

How can I stop ear wax coming back?

Wax production, and the degree of problems this produces, will vary from person to person. As described above, cotton buds should be avoided. Care should be taken with hearing aids, headphones and ear plugs, as these may impact the wax.

Otherwise, there is not a reliable way to stop wax coming back. Some people try to use ear drops regularly, but these may make the wax so soft and gloopy that it finds its way deeper into the ear canals, creating more symptoms. For this reason, I would advise against regular use of ear drops, unless your doctor has recommended them. However, careful use of drops for two weeks in the run up to an appointment for wax removal may be very helpful.