Earwax

Earwax, or cerumen, is an oily substance produced by glands in the ear canal. It is usually yellow to brown in color, but the amount produced and texture can vary from person to person. However, as earwax tends to become harder and drier with age, problems are more likely to occur in the elderly.

Chewing and other jaw movements help to move earwax from inside the ear canal towards the visible, fleshy part of the ear (pinna). As earwax travels along the ear canal, it collects hair, dead skin cells, dust and bacteria. As well as preventing these foreign substances from travelling deeper into the ear, it also gives the ear canal a protective coating. Without earwax, the skin inside the ear canal would become dry and itchy.

In some people, a build-up of earwax can cause a mild hearing loss and a feeling of fullness in the ear. Less commonly, symptoms can include earache, ringing in the ears (tinnitus) and mild dizziness (vertigo). In most cases though, earwax flakes off and falls out of the ear on its own. Hearing usually returns to normal without the need for treatment.

A build-up of earwax may be treated by applying softening ear drops or having the wax professionally removed by your doctor.

Causes

The ear is made up of three main parts: the outer ear, middle ear and inner ear. The outer ear consists of the external part of the ear, made of cartilage and bone, which leads to the eardrum. Earwax is constantly produced by specialized glands in the outer ear canal, which is located between the opening of the ear and the eardrum.

It is not always clear what causes a build-up of earwax. However, it tends to be more common in people who naturally produce large amounts of dry earwax. Earwax that collects a lot of foreign substances or remains in the ear canal for a long time is also more likely to dry out and form a build-up. The chance of a build-up also increases with age due to increased hair growth in the ears and slowed movement of earwax out of the ear canals over time. A build-up may also be caused by pushing earwax deeper into the ear canal as a result of cleaning with cotton buds, or frequent use of earphones or hearing aids.

Earwax build-up in the outer ear canal. 

Signs and symptoms

Although earwax is usually harmless, a build-up can sometimes cause:

• Mild hearing loss;
• A feeling of fullness in the ear;
• Earache;
• Ringing in the ears (tinnitus), and;
• Mild dizziness (vertigo).

Similar symptoms can also be caused by other medical conditions, rather than a build-up of earwax. For this reason, visiting your doctor for diagnosis is recommended if symptoms are ongoing or getting worse.

A build-up of earwax can result in a mild hearing loss. 

Methods for diagnosis

To examine a build-up of earwax, your doctor will most likely examine the ear with an instrument called an otoscope. If an underlying medical condition is suspected, you may be referred to an ear, nose and throat (ENT) specialist for further testing.

Examination of the outer ear canal using an otoscope. 

Types of treatment

In most cases, earwax flakes off and falls out of the ear canal without the need for treatment. However, if you experience discomfort or hearing loss, your doctor may suggest one or more of the following treatment options:

Self care

Softening the earwax at home may help it to fall out on its own. Some examples of substances that can be dripped into the ear include baby oil, olive oil, mineral oil or glycerin.

If the build-up remains after a day or two, squirting warm water into the ear canal with a syringe (ear irrigation) may dislodge the softened earwax. Side effects related to ear irrigation can include mild inflammation, itching and short-term dizziness (vertigo).

Consulting your doctor for advice on how to prepare and use these treatments is recommended. Ear irrigation is not a suitable treatment if you have recently had an ear infection (middle or outer) or burst eardrum.

Removing earwax at home with a cotton bud or hairpin can push it further into the ear. Due to the risk of causing damage to the ear canal or eardrum, this practice is not recommended. Similarly, using an ear candle to draw out wax was a common treatment in the past, but is no longer advised due to the risk of burns or ear damage.

Earwax removal

In cases where build-up of earwax is severe or ongoing, it may be necessary to visit your doctor to have it removed. Rather than using a syringe, your doctor may perform ear irrigation with an electronic device that squirts the water in a controlled manner.

If ear irrigation is unsuccessful, your doctor may remove earwax with a specialized suction device or a small, curved instrument called a curette.

Medications

For an ongoing build-up of earwax, your doctor may suggest an ear-drop medication to soften earwax. Examples of these medications include carbamide peroxide, dichlorobenzene with chlorbutol, or docusate. Side effects can include irritation of the ear canal and eardrum.

Potential complications

Complications from a build-up of earwax are uncommon, with many cases clearing without treatment in a week. However, sometimes existing symptoms, such as hearing loss, earache, dizziness (vertigo) and ringing in the ears (tinnitus), can get worse if left untreated.

In cases where there is a large build-up of earwax lodged firmly in the ear canal, an ear infection may occur. As the build-up of wax and infection are sometimes related, one or both conditions may keep coming back over time.

Prognosis

Earwax is a natural substance that helps to keep the ear canals clean and healthy. Although a build-up may sometimes cause mild pain and discomfort, the condition is usually harmless and easily treated. In many cases, the build-up becomes loose and falls out on its own, without the need for treatment.

Prevention

While it is not possible to reduce the amount of earwax produced, using ear drops on a regular basis may prevent build-ups by keeping wax soft. Pushing wax further into the ear may be avoided by only cleaning the outer, visible part of the ear, rather than using a cotton bud or other object. Treating eczema or any other contributing medical condition may also help to prevent a build-up of earwax.