Earwax Removal

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

Earwax definition and facts

  • Earwax (ear wax) is a natural substance produced by glands in the skin of the outer ear canal.
  • The wax acts as a helpful coating for the ear canal so removal of it is not necessary. However, in cases of blockage or excessive buildup, it may be necessary to try to remove the impacted or excessive wax.
  • Excessive wax buildup can be caused by putting small things in your ears like a hearing aid, hair pins, headphones, Q-tips, etc. Putting these things in your ear pushes the wax further down the canal. Never stick anything in your ear, including cotton swabs.
  • Signs and symptoms of wax buildup include:
  • There are a number of safe, natural ways to remove earwax at home; however treatment by a doctor or other health-care professional may be necessary.
  • A variety of products and aids available over-the-counter (OTC) for treatment and removal of excessive wax, for example, irrigation kits, which usually include a bulb syringe. Most kits cost less than $20.00.
  • Excessive wax usually only takes a few minutes to remove.
  • The type of doctor or other health-care professional to see if you need your ears cleaned include primary care, pediatricians, or ear nose and throat specialists (otolaryngologists).
  • Ear candling is not a recommended way to remove earwax because it poses health risks.
  • You can help prevent excessive wax buildup if you and don’t push or put objects in your ears and care for them properly. Currently, there are no other effective methods available to prevent buildup.

What is ear wax?

The skin on the outer part of the ear canal has special glands that produce ear wax, also known as cerumen. We have this natural wax is to protect the ear from damage and infections. Normally, a small amount of wax accumulates and then dries up and falls out of the ear canal, carrying with it unwanted dust or sand particles.

Ear wax is helpful to coat the skin of the ear canal where it acts as a temporary water repellent. The absence of ear wax may result in dry, itchy ears, and even infection. Ear wax is formed in the outer third of the ear canal.

Why does earwax vary in color and texture?

Cerumen varies in form, color, and appearance from person to person.

  • It may be almost liquid, firm and solid, or dry and flaky.
  • The color of ear wax varies depending upon its composition.
  • Glandular secretions, sloughed skin cells, normal bacteria present on the surface of the canal, and water may all be in earwax.

Ear Wax Illustration
Ear Wax Illustration

The ear canals are considered to be self-cleaning. This means that ear wax and sloughed skin cells typically pass on their own from the inside of the ear canal to the outer opening. Old earwax moves from the deeper areas of the canal out to the opening. At the opening of the canal the ear wax usually dries up and falls out of the canal.

Is it OK to remove earwax blockage?

Under ideal circumstances, a person should never need to clean his or her ear canals. However, sometimes removal of wax is necessary and requires medical treatment.

What causes wax in the ears to build up?

You can have excessive earwax build up and harden by:

  • Narrowing of the canal resulting from infections or diseases of the skin, bones, or connective tissue
  • Production of a less fluid form of cerumen (more common in older persons due to aging of the glands that produce it).
  • Overproduction of cerumen in response to trauma or blockage within the canal.
  • Things that you put in your ears to clean them like swabs, Q-tips, hair pins or keys.
  • Hearing aids
  • Earphones that are placed inside the ears

What signs and symptoms are related to excessive or impacted (plug) earwax?

Excessive wax in the ears can cause different symptoms and signs, including:

When wax plugs the ear canal it can affect your hearing. Researchers estimate that hearing can be improved by 10 decibels when the plug is removed.

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Earache (Ear Pain) Symptoms

Pain in the ear can occur because of conditions within the ear, the ear canal, or affecting the visible portion of the ear.

Symptoms of impacted ear wax that may cause ear pain include:

  • Hearing problems
  • Ringing in the ears
  • Cough
  • Itching in the ear canal and round the ear
  • Discharge from the ear

Is ear candling safe?

Ear candling involves placing a hollow candle (made from a fabric tube soaked in beeswax) in the ear canal and burning it, with the goal of creating a suction force for removal of wax from the ears. According to the American Academy of Otolaryngology- Head and Neck Surgery, ear candling or ear coning is not considered a safe option for ear wax removal. Studies have shown that the procedure does not create a vacuum that can remove the wax effectively, and it the wax left inside candle is from the candle itself, not from the ear. The procedure also carries health risks that include burns to the ear canal, development of new blockage of the canal from the candling wax, ear infection, and perforation of the eardrum.

What are the treatment guidelines for impacted earwax removal?

In January, 2017, the American Academy of Otolaryngology- Head and Neck Surgery released new practice guidelines to treat impacted earwax. This guideline was endorsed by a number of other medical organizations including the American Academy of Pediatrics (AAP). This guideline discusses four ways to care for and manage impacted earwax.

  1. Observation, since many impactions or blockages may clear on their own
  2. Softening agents, known as cerumenolytics. These are oils or ear drops that soften or break up the wax to help in removal.
  3. Irrigation, or ear syringing. This is clearing the wax using a stream of warm water into the ear canal. This can sometimes be done at home. This method is not suitable for people who have frequent ear infections or who have a perforated eardrum or surgically inserted ear tubes.
  4. Physical removal using a suction device or instrument. This should always be done by a doctor or other health-care professional.

What over-the-counter (OTC) products remove earwax build up safely at home?

Many people will respond to treatment with natural and home remedies, for example:

  1. Use a few drops of warmed olive oil, mineral oil, almond oil, baby oil, or glycerin ear drops or sprays in the ear to soften the wax.
  2. Use hydrogen peroxide drops.
  3. Over-the-counter (OTC) products are available for wax removal, such as Debrox or Murine Ear Drops.
  4. Syringe bulbs or irrigation home kits

If the ear still feels blocked after using these drops, call a doctor for an exam. If you try OTC earwax softeners, it is imperative to know that you don’t have a punctured (perforated) eardrum prior to using the product. If you have a punctured eardrum and put softeners in the ear it may cause a middle ear infection (otitis media). Similarly, simply washing the ear with a punctured eardrum may start an infection. If you are uncertain whether or not you have a hole in your eardrum, consult a health-care professional.

Some people may also be hypersensitive to products designed to soften earwax. Therefore, if pain, tenderness or a local skin rash develops, the use of these drops should be discontinued.

When wax has accumulated so much that it blocks the ear canal (and interferes with hearing), a health-care professional may need to wash it out (known as lavage), remove it by suctioning, or remove it with special instruments. Alternatively, a doctor may prescribe ear drops that are designed to soften the wax (such as trolamine polypeptide oleate-ear drops [Cerumenex]).

Is it OK to use Q-tips or other objects to remove excess earwax?

Most attempts to clean the ears by using cotton swabs only result in pushing the wax further into the ear canal. Wax is not formed in the deep part of the canal near the eardrum, but only in the outer part of the canal near the external opening. So when a doctor sees with wax pushed up against your eardrum, he or she knows that it often is because you have been probing your ear with things like Q-Tips, bobby pins, or twisted napkin corners. These objects only serve as ramrods to push the wax deeper into the ear and can lead to problems.

The skin of the ear canal and the eardrum is very thin and fragile, and is easily injured. The ear canal is more prone to infection after it has been stripped clean of the "good," coating-type wax. Doctors see many perforated eardrums as a result of the above efforts. If you have symptoms or signs of impacted earwax consult with your doctor.

REFERENCE:

American Academy of Otolaryngology- Head and Neck Surgery. "EarWax and Care."
<http://www.entnet.org/content/earwax-and-care>

Rogers, N., MD. et al. "Ear wax removal: Help patients help themselves." J Fam Pract. 2011 Nov; 60(11): 671–673.
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273968/>

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Reviewed on 2/14/2017
References
REFERENCE:

American Academy of Otolaryngology- Head and Neck Surgery. "EarWax and Care."
<http://www.entnet.org/content/earwax-and-care>

Rogers, N., MD. et al. "Ear wax removal: Help patients help themselves." J Fam Pract. 2011 Nov; 60(11): 671–673.
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273968/>

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