Earwax

Earwax acts as a natural barrier that prevents bacteria and dirt from entering the innermost parts of the ears. However, if it builds up, it can cause severe ear pain and infections by irritating the ear walls and impairing hearing. Earwax buildup and blockage may cause the following symptoms:

• Itchiness in the ear
• A feeling of fullness in the ear
• Foul odor or discharge from the ear
• Ear pain
• Otalgia (ear infection with pain)
• A sensation of air trapped in the ear or plugged
• Tinnitus (ringing or noises in the ear)
• Partial hearing loss or decreased hearing
• Dizziness
• Cough
• Vertigo

Want to learn more about ear pain? Read to know about the 5 common causes of ear pain and how to deal with them. Tap here.

Earwax is a sticky substance composed of dead skin cells, sweat mixed with dirt, and oil. The sweat glands in the skin of the human external auditory canal, along with sebaceous glands, produce earwax. It has lubricating and self-cleaning properties, as well as protective, emollient, and bactericidal effects.

Earwax buildup can occur due to:

• Failure to self-clear because of slow skin migration
• Inserting small objects such as cotton buds, hairpins, or headphones into the ears, which can push the wax further down the ear canal

• Anatomical deformities such as narrow ear canals or ear canals that are not fully formed.
• Very hairy ear canals.
• Benign (non-cancerous) bony growths or osteomas in the outer part of the ear canal.
• Certain skin conditions like eczema.
• Older age.
• Recurring ear infections.
• Auto-immune conditions such as Sjogren’s syndrome and Lupus.
• Individuals with a gene variant ABCC11 in their DNA.
• Use of cotton buds to clear earwax.

Diagnosing earwax blockages or impaction often only requires a medical history and physical examination by an ear, nose, and throat (ENT) specialist.

Medical History

An ENT specialist will ask several questions related to the symptoms you may be experiencing. Your doctor may also inquire about any history of major or minor ailments or ear surgery.

Physical Examination

During your physical exam, your ENT specialist will inspect parts of the ear including:

• Outer ear
• Middle ear
• Inner ear
• Ear canal
• Tympanic membrane (eardrum)

This inspection is performed using an otoscope, a medical instrument that shines a beam of light for visual examination of the eardrum and the passage of the outer ear.

Some individuals may not accurately convey symptoms, such as those suffering from dementia, developmental delays, nonverbal individuals with behavioral changes, and young children with fever, speech delays, or parental concerns. In these cases, earwax is removed when it limits examination.

Note: Earwax can also compromise vestibular testing, a series of tests that evaluate hearing function, and should therefore be removed before these tests are performed.

Mostly, the ears clean themselves by slowly moving earwax out of the ear canal opening. However, excessive blockages of earwax can be prevented with the following tips:

• Don’t use long objects for earwax cleaning as it can damage the ear canal or eardrum, or push earwax farther into the canal.
• Never insert earbuds or other devices deeper into the ear canal for earwax cleaning, as it may push the wax more inside and irritate the ear wall, leading to serious infections.
• Use earplugs while taking showers or swimming. This will help prevent infection by blocking the entry of moisture or water droplets.
• Always dry your outer ear by gently cleaning it with a cotton swab. This will help avoid trapping water or moisture inside the ear canal.
• Use OTC ear drops to soften and remove earwax if you have a history of producing excessive earwax.
• Do not irrigate your ears frequently as this can inflame the ear canal and cause pain or ear infection.
• Avoid ear candling, as it has not been proven to be safe or effective, and can be dangerous.

Listen to our experts talk about the correct way to clean your ears. Watch this video now.

Earwax blockage can be treated or removed in several ways. The most common methods include:

1. Irrigating or syringing with warm water
   It is one of the most common processes used to clean earwax. Your doctor will fill a syringe with lukewarm water to rinse out the ear canal. In some cases, your doctor may use saline solution instead of warm water. Finally, your doctor can check and remove any remaining wax manually using special instruments such as spoons, forceps, or suction devices.
   Note: Irrigation should not be performed if you have a history of ear surgery or anatomical abnormalities of the ear canal (birth defect).
2. Microsuction technique
   The removal of impacted earwax requires an instrument for visualization such as an otoscope, headlamp, or binocular microscope, along with a micro-suction device and a thin long tube. During this procedure, your doctor fits a thin nozzle in your ear to vacuum out the wax by applying gentle pressure with the help of a suction pump.
3. Medicines
   Over-the-counter (OTC) drugs or topical solutions are available to clear earwax blockages. These preparations are also known as cerumenolytics (solutions to dissolve wax) and commonly used options include:
   • Hydrogen peroxide
   • Sodium bicarbonate
   • Carbamide peroxide
   You can also use some natural cerumenolytic solutions in the ear canal, including:
   • Mineral oil
   • Baby oil
   • Glycerin
   • Saline solution
4. How to use the drops?
   Put a few drops of solution into the ear with a dropper and lie down for at least 5 minutes. You may hear a bubbling sound inside your ear, which is normal and due to the foaming action of earwax removal. After a few minutes, lie on the opposite side so that the solution can rinse out of the ear canal containing the dissolved wax. Clean the outer part of the ear with a small piece of cotton.

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By using topical solutions or cerumenolytics, removal of earwax can be done at home. However, earwax build-up can sometimes create pain, foul discharge, and a feeling of fullness in the ear. These symptoms can be alleviated at home with simple remedies. Ensure to obtain consent from your healthcare provider before trying these home remedies:

• Chewing gum: If your ears are plugged or you feel fullness after earwax removal, chewing gum can relieve pressure in the middle ear. If this doesn’t work, try taking deep breaths and gently blowing out of your nose while pinching your nostrils closed.
• Honey (Shahad): Earwax blockages can sometimes cause a cough. Honey, due to its mucolytic properties, is an effective home remedy. You can consume a spoonful of honey or mix it with warm water.
• Ginger (Adrak): With its natural anti-inflammatory properties, ginger can help soothe a sore throat or cough. Applying ginger juice around the outer ear canal may relieve ear pain.
• Olive oil: A few drops of olive oil in the affected ear can act as a lubricant, helping to eliminate infection and blockages caused by earwax.
• Garlic (Lehsun): Known for its antibiotic and analgesic properties, garlic can be used to relieve symptoms. Warm a few cloves of garlic in eucalyptus oil, cool, filter the oil, and apply a few drops around the outer parts of the affected ear.

If excessive earwax is not removed, it may exacerbate the symptoms of earwax blockage. Other complications include:

• Perforated eardrum: A ruptured eardrum is a tear or hole in the thin tissue (tympanic membrane) that separates the outer ear from the middle ear. An untreated ruptured eardrum can cause severe pain due to infection.
• Note: A perforated eardrum can also be caused by loud music, head injury, or any foreign entity in the ear.
• Middle-ear infection: Some individuals may develop inflammation in the ear canal and subsequently an ear infection after irrigation. Earwax acts as a physical barrier, preventing the entry of bacteria, dirt, and other debris into the ear. Therefore, complete removal can lead to middle ear infections. Most mild infections resolve on their own, but in some cases, antibiotic ear drops may be necessary.
• External-ear infection (swimmer’s ear): This condition does not imply that one is a regular swimmer. It occurs when moisture or water is trapped in the ear canal, causing pain and a sensation of blockage. This can result from activities such as taking showers, washing hair, or being in a moist or humid environment.