Ear wax (cerumen)

What is ear wax?

Ear wax (also known as cerumen) is a yellow or brown coloured substance secreted into the ear canals of humans and other animals. Ear wax contains secretions from two types of small glands in the ear canal (ceruminous and sebaceous) as well as dead skin cells and hairs. The secretions from the glands contain proteins and fats that assist with protecting the ear canal skin from infections

What does ear wax look like?

Ear wax from European people tends to be a brown or yellow colour (known as wet ear wax). Ear wax from people of Asian origin tends to gray coloured and more dry and flaky (known as dry ear wax). In people with lots of hair around the entrance to the ear canal (eg older men) it can also be full of dry hairs. Ear wax often becomes drier and more flaky with age.

What is the purpose of ear wax?

Ear wax is actually very helpful in the ear canal. Skin cells lining the eardrum are constantly replaced and work their way out of the ear canal in a conveyor belt manner. Ear wax takes these cells with it including any dirt, insects, bacteria, hairs or other debris that might have become stick in the ear canal.

Ear wax lubricates the ear canal skin preventing itchiness, dryness and a burning feeling. Ear wax also helps to prevent ear infections by providing a protective barrier against both bacteria and fungi.

What symptoms can ear wax cause?

Unfortunately sometimes excess ear wax can cause problems. Ear wax that blocks the ear canal can cause hearing loss. This can be associated with “autophony” where one hears one’s own voice louder when speaking. It can also cause water to become trapped behind it leading to painful outer ear infections.

Ear wax can interfere with the function of hearing aids. It is estimated up to 80% of hearing aid faults are caused by ear wax. Unfortunately hearing aids tend to promote ear wax impaction by interfering with the normal migration patterns.

Are cotton buds / Q tips ok to use to clean out ear wax?

No. Cotton buds (q tips, cotton swabs) cause a huge number of ear problems and should never be placed in the ear. Most of the time they simply push ear wax further back into the ear canal and just touch the top of the wax. If pushed in too far they can occasionally perforate the ear canal. By removing all ear wax, the ear canals can then become more susceptible to infections and to a burning, dry feeling.

The simple answer is NEVER place a cotton bud in your ear and your ears will be much healthier and feel better!

How can ear wax be removed?

Most of the time the ears will clean wax out themselves. You never need to use a cotton bud to try and remove wax from child’s ears. Generally you do not need to try and remove ear wax unless it is causing a problem. Remember it is actually helpful and is serving a purpose.

If the wax does become excessive and is causing problems there are a few ways to deal with it that we will discuss in three catergories.

  1. Softeners
  2. Ear irrigation
  3. Suction, curettes, other instruments

Ear wax softeners
There are many commercial products available that soften ear wax. Examples include Waxsol, Cerumol and Earclear. They are all useful at softening ear wax and aiding removal. If the wax impaction is severe they may need to be used for many days in order to obtain relief.

Ear wax softeners are also useful to use in the days leading up to seeing a doctor to help with ear wax removal. Softer wax is easier to remove than very hard wax. So if you are thinking about seeing your GP or a specialist to remove ear wax it is a good idea to use some wax softening drops for the week leading up to that. To be safe, x 3 a day for 5 days is a good idea.

A longstanding simple treatment for ear wax is 3% hydrogen peroxide. You do not need a prescription for this as it is available from most chemists and supermarkets. Take a 3 or 5 mL syrgine, squirt some hydrogen peroxide in your ear and let it bubble and fizz for about a minute. You can do this multiple times a day. It is very safe to do even in the setting of a perforated ear drum, an ear infection or in a child with grommets (ventilation tubes).

Ear irrigation
Ear irrigation can be very effective at removing ear wax. There is a bit of skill in applying the correct technique. The ear needs to be held slightly backward and upward and then the nozzle aimed high to allow water to flow out down below. Ideally this allows water to flow in and out easily bringing the wax with it. Warm water is more comfortable than cold.

Unfortunately many things can go wrong with ear irrigation. If the procedure is painful it should be immediately stopped or the flow speed reduced. Cold water in the ear canal can cause temporary vertigo (dizziness). The wax may be too densely impacted to allow water to flow behind it and push it out. Water that is pushed into the ear canal too forcefully can cause a hole (perforate) the ear drum. Sometimes water becomes trapped behind the ear wax and can cause an outer ear infection (otitis externa).

Ensure your GP always inspects the ear canal after irrigating to ensure all wax has been removed.

Suction and curettes
An otolaryngologist (ENT specialist) will look directly down your ear canal with a microscope. They can then use very fine suction and other micro instruments to carefully remove the ear wax. No water/irrigation is needed with this technique and it is very safe and comfortable. Softer wax is easier to deal with than very hard wax.

A note on ear candling
Ear candling is an alternative medicine practice that claims to improve a person’s health by lighting a candle near the ear canal. It is dangerous and ineffective. Studies have shown that ear candles do not generate any negative pressure and do nothing to remove ear wax. Often wax is deposited rather than removed. Serious injury can occur from this practice and it should never be performed.

You can read more about ear candling here. Seely DR, Quigley SM, Langman AW (October 1996). “Ear candles–efficacy and safety”. The Laryngoscope 106 (10): 1226–9. doi:10.1097/00005537-199610000-00010. PMID 8849790.

How does Dr Roth remove ear wax?

The first step is a consultation to discuss any history of ear disease, trauma or other ear issues.

You are then made comfortable on a soft reclining chair with a head rest. A microscope is setup to provide a magnified view of the ear canal and inspect the degree of wax impaction. Dr Roth uses a sterile suction machine to very carefully remove ear wax slowly and gently. No water is used and there is no pressure or pain. There is no risk of infection. The ear drum can be seen when the wax is removed. Small instruments are sometimes used to gently loosen very dry, stuck wax off the skin of the ear canal. These instruments are smooth and have no sharp edges. All wax will generally be removed. Occasionally wax may be too impacted to remove all of it in one sitting. In that case wax softening drops are used for a few days before the remainder can be removed.

Dr Roth also works with a number of associates who may be available to remove ear wax at short notice if Dr Roth is booked out or is doing surgery at the hospital.