Updated: Aug 15, 2018
Ear wax is HEALTHY and ears are SELF-CLEANING. It is produced by the ear on purpose for some very good reasons that I will discuss in this article.
What is it?
Ear wax consists of dead skin cells, mixed with or sebum from modified sebaceous glands in the ear canal.
How is it made?
The skin deep in our ear canal constantly sheds dead skin cells. The skin that lines the ear canal grows outwards towards the entrance of our ear and those dead skin cells move along with it. When the cells get to about a third of the way out, they mix with sebum to form the yellowy-brown substance we know as ear wax. This continues to migrate out of the ear, trapping dust and debris, and once it reaches the skin of the outer ear it either naturally falls out, washes out when we have a shower or bath, or just naturally dries out.
Why is it there?
It keeps the ear clean and it removes dead skin cells. Normally, the dead skin on the rest of our body just flakes away but because the ear canal is tube shaped it has adapted this ear-wax-mechanism to help the process of getting rid of the dead skin. The dead skin cells are removed from the ear canal via the ear wax, along with any dust, debris or foreign objects that get into the ear.
It is naturally anti-microbial. This means it can resist bacteria, helping to prevent ear infections.
It helps to keep the ear moisturised. It is a natural lubricant and stops our ears from getting too dry and itchy.
Because it is bitter and acidic, it keeps insects at bay (personally my favourite reason, I have an irrational fear of a spider crawling into my ear and laying eggs. Thanks internet.)
How do I clean my ears?
Well, having a little bit of wax in your ears does not mean your ears are dirty. And hopefully we’ve established that you don’t really want to remove the natural ear wax if it’s superficial. Generally, if you’re a clean person and you wash every day, you shouldn’t have visible ear wax and there should be no need to ‘clean’ your ears. Technically, they are self-cleaning and this process shouldn’t be disturbed.
However, if the wax is blocking your hearing, causing pain or discomfort and fully occluding the ear canal, it will need to be removed by a registered clinician.
How do I know if the wax needs to be professionally removed?
Here are some of the symptoms to look out for:
Hearing loss. If you feel your hearing is reduced or worse than usual, it may be a sign of occluding ear wax. You should get your ears looked at by a medical professional to confirm if it is wax or not. Please bear in mind though that there may be underlying hearing loss caused by something else, and sometimes wax removal does not always resolve the problem.
Pain. Sometimes, if the wax is completely occluding, as well as hearing loss you will feel a sensation of pressure in the ear or down the side of the face. However, pain can be a sign of ear infection too, so get it checked out by a nurse, GP or audiologist as soon as possible.
Tinnitus. If you already have tinnitus, it may appear to get worse if there is a blockage. Or you may develop tinnitus if the ear is completely blocked. But this should disappear or improve once the wax has been removed
If you are a hearing aid user you may notice the hearing aids are whistling if there is a build up of wax, or that they repeatedly get blocked with wax.
If you are an in-ear headphone user you may also notice interference with sound quality. The sound coming from a headphone is directional. If you notice there is a difference in volume then it may be that there is a lump of wax blocking the sound.
Water getting trapped in the ear canal. Water will normally, eventually, come out of the ear canal if you shake your head a little to break the surface tension. But if it doesn’t, and you have a history of wax build up, it may be a sign of a large quantity of wax in your ear. The water either gets trapped behind the wax and can’t come out as easily or it causes the wax to expand, blocking the ear.
However, if you are not blocked up, and your hearing is ok, I would advise to leave your ears alone. I don’t condone regular professional cleaning (unless there is a strong history of ear wax related problems) or unnecessary cleaning.
What methods of wax removal can I use?
If your ear blocks, the wax should be removed professionally. If you choose to get it syringed/irrigated then you will need to start softening it with olive oil for between 3-10 days before the appointment.
These days you can quite easily get it removed using microsuction. This is my preferred method, and is considered the gold standard of wax removal amongst ear, nose and throat professionals in the UK. You normally have to pay for it privately, but it generally does not require the use of olive oil beforehand and so you can be treated immediately. Also, because no water is required there is less risk of infection and trauma to the ear. It is also safe to use on all types of ears, even if there is a history of ear drum problems or ear operations.
There is a school of thought that olive oil can be used for a few days first to see if it helps to dislodge the wax, so as a treatment in itself. And as long as it is just plain olive oil (Earol is the best brand in my opinion) there is no harm in doing this, but it depends how blocked you are. As soon as you put oil in the ear, initially it will cause the wax to expand and you may feel even more blocked. So if you can’t face being even more blocked for the next few days, the easiest thing to do to is to track down someone in your area who provides microsuction and you can usually get it removed the same or next day.
What not to do
DO NOT USE A COTTON BUD in your ear canal. You don’t know how much wax you have in your ear and if it’s a fair amount, you risk compacting it and pushing it further in, blocking your ear and then you will definitely need a professional to remove it. You also risk damaging your ear. You can scratch and traumatise the delicate skin of the ear canal which can lead to infection (and it also hurts) and worst case, if you go too far, you can perforate your ear drum (this hurts too).
DO NOT USE HOPI CANDLES. This ‘treatment’ involves sticking a tube of cotton that is on fire in your ear. It carries a high risk of burns and trauma, and there is no evidence that it is an effective method of wax removal. In fact in America they have guidelines that recommend to NOT use hopi candles because they are dangerous and don’t work.
AVOID anything that has hydrogen peroxide as an ingredient. This is strong stuff, often burning the skin. You can always tell an ear that’s had a hydrogen peroxide product in because it is bright red and angry looking. Furthermore, it liquifies the wax and then the liquid wax coats the ear canal and the ear drum, re-solidifies, and then your ear drum can’t vibrate properly and you’re left feeling even more blocked. It also makes removal of the wax by a clinician much more difficult.
AVOID sodium bicarbonate too if you can. Our official guidelines state that it can be used/recommended, but only if olive oil has been tried first and not worked. And if olive oil has not worked it means it is stubborn wax and will likely need a professional to remove it. The reason I recommend avoiding sodium bicarbonate is because, like the hydrogen peroxide, it is irritating stuff to put in your ear, making it angry and drying out the skin.
I hope it goes without saying that anything that is pointy looking and promises to remove all ear wax and has exclamation marks in the product name should also be avoided.
Why am I prone to wax build up?
Skin condition. If you have eczema, psoriasis or are just prone to dry skin, you are more likely to have regular occluding wax build up. Not only do you produce a lot of flaky skin quickly (remember that wax consists of dead skin cells) but the wax that is produced will often stick to the dry wall of the ear canal and not exit the ear canal in the way it does in a well-lubricated ear.
Genetics. There is some evidence that shows a propensity for occluding ear wax can run in the family.
Anatomy. Every ear is different. Sometimes, the shape of the ear canal will impede the natural migration of wax and you will get a build up. If the ear canal is narrow, it won’t take much wax to block it. Sometimes ears are very hairy and this impedes the movement of ear wax, leading to a build up.
Blocking the entrance of the ear canal. If you wear hearing aids, ear plugs, or custom ear devices like in-ear-monitors or headphones, you are physically stopping the wax from naturally falling out of the ear, thus encouraging a build up of wax. This is a downside to the above-mentioned product, but you still need to wear these devices! My advice would be to locate a local ear wax removal specialist, ready for when, and just in case, a blockage occurs.
Random/bad luck/idiopathic. Sometimes, it just randomly happens, and we have no explanation. I’m sorry. (Idiopathic is a fancy medical term we use when we don’t know what the cause is).
How often should I get my ear wax professionally removed?
The process of dry skin shedding, migrating out of the ear and mixing with the sebum to form wax is about 12 months. So if you’re prone to wax build up, it will be roughly every year. For many though, it’s just a few times in their life. For an unfortunate few, it’s twice a year or more. Again, my advice would be to find a local expert so that if you do block up you know it can be resolved quickly and quality of life is not affected.
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