Definition and Frequency
Earwax (cerumen) is a natural secretion produced by glands in the outer ear canal. Contrary to popular belief, it is not dirt but a protective substance that moisturizes the ear canal, protects the skin and forms a barrier against infection. Under normal conditions, earwax moves outwards along the ear canal on its own, with jaw movements and the renewal of skin cells, and is expelled. In some people, however, overproduction, the anatomy of the ear canal or incorrect cleaning habits can cause earwax to accumulate and form a plug (impaction). A wax plug is a common reason for attending ENT outpatient clinics and can affect every age group.
Earwax is in fact made up of a mixture of the secretions of the oil and sweat glands in the skin of the outer ear canal and shed skin cells. This mixture keeps the ear canal in an acidic environment, suppressing the growth of bacteria and fungi; it also acts as a natural trap that prevents dust, dirt and small foreign bodies from reaching the eardrum. The colour and consistency of earwax vary from person to person, and even according to ethnic characteristics; in some people it may be wetter and stickier, in others drier and flaky. This natural variation is not, on its own, a sign of disease.
Symptoms
The most common symptom of an earwax plug is a feeling of fullness in the ear. This may be accompanied by reduced hearing, ringing (tinnitus), itching and occasionally mild pain. Symptoms usually become more noticeable after contact with water (a shower, swimming), because earwax can swell on contact with water and block the ear canal further. One-sided hearing loss, dizziness or a humming sensation in the ear may also be due to a wax plug. In some patients, ringing in the ear or a mild loss of balance may develop because the plug presses on the eardrum.
The severity of the symptoms depends on how much of the ear canal the plug fills. Earwax that fills part of the ear canal often causes no symptoms at all, whereas a dense plug that completely blocks the canal can cause sudden and marked hearing loss. In some patients — particularly hearing aid users — the device suddenly becoming less effective or producing crackling sounds can also be a sign that a wax plug has formed. In children, hearing loss due to a wax plug can also show itself through signs that may be misinterpreted, such as attention problems or lack of interest in lessons.
Causes and Risk Factors
The main causes of earwax build-up include an individual tendency to produce thicker earwax, a narrow or curved ear canal and dense hair in the ear canal. One of the most important risk factors is the use of cotton swabs (cotton buds); instead of cleaning out the earwax, these push it deep into the ear canal towards the eardrum, causing the plug to grow. Using hearing aids or earplugs and listening to music through earphones for long periods disrupt the ear canal’s natural self-cleaning mechanism and make build-up easier. Because earwax can become drier and harder in later life, wax plugs are more common in older people.
Developmental characteristics may also play a role; in some conditions such as Down syndrome the ear canal may be narrower, so wax plugs are more common. Previous surgery on the ear canal, narrowing of the ear canal or chronic skin diseases (eczema, seborrhoeic dermatitis) can also make it harder for earwax to be expelled normally. In addition, the habit of cleaning the ears oneself frequently and at irregular intervals can irritate the skin of the ear canal and encourage both greater secretion and plug formation; this paradoxical situation shows the importance of the principle “not too little cleaning, but the wrong kind of cleaning”.
Diagnostic Process
The diagnosis is easily made by otoscopic examination. The physician examines the ear canal with a lighted instrument (otoscope) or a microscope and assesses the amount and consistency of the earwax and its distance from the eardrum. When the complaint is accompanied by hearing loss, a hearing test (audiometry) may be performed after the plug has been removed to check whether hearing has returned to normal. With dense plugs through which the eardrum cannot be seen, re-examination after cleaning is important to assess whether there is an additional problem underneath, such as a perforated eardrum.
The appearance of the earwax during the examination can also be informative: a dark brown-black, hard and dry plug usually indicates earwax that has accumulated over a long time, whereas soft, light-coloured earwax may have formed more recently. Plugs located close to the eardrum can press on it and cause more marked hearing loss and a feeling of fullness. If the ear canal cannot be seen completely on otoscopic examination, it may be difficult to make a definite diagnosis before cleaning; for this reason cleaning is regarded as both a diagnostic and a therapeutic step.
Treatment Options
Conservative Treatment
The treatment of an earwax plug is professional cleaning in the clinic. This can be carried out by aspiration (vacuum suction), mechanical cleaning with special ear instruments (curette, forceps) or irrigation (rinsing) with lukewarm water. The procedure is usually painless and takes a few minutes. For hard, dense plugs, using softening ear drops for a few days beforehand can make cleaning easier. Irrigation is not preferred in patients with a history of a perforated eardrum or an active infection; in these cases mechanical cleaning or aspiration are safe alternatives.
Surgical Treatment
An earwax plug does not require surgical treatment; the procedure is completed entirely in the outpatient clinic using non-surgical methods. However, in rare patients whose ear canal is anatomically very narrow, who experience recurrent wax plugs or in whom a narrowing (stenosis) of the ear canal is found, evaluation and, if necessary, surgical correction of the underlying structural problem may be considered. In patients with such structural problems, planning professional cleaning at regular intervals is the preferred approach for preventing large plugs from forming in the future.
Recovery and Follow-up
After professional cleaning, the feeling of fullness and reduced hearing usually improve immediately. Cleaning with home methods such as cotton swabs, hairpins or matches is strongly discouraged; such attempts can push the earwax further in and enlarge the plug, cause scratches in the skin of the ear canal and a resulting infection, and can even perforate the eardrum. In people who frequently develop wax plugs, avoiding cotton swabs and, when necessary, periodically using softening drops is recommended. For patients with recurrent plug complaints, ENT check-ups at regular intervals are beneficial.
After cleaning, temporary dizziness or mild ringing in the ear may rarely be felt; this usually passes on its own in a short time. Because wax plugs may recur more often in patients who use hearing aids, ear check-ups at regular intervals (for example every six months) are recommended for this group. Because an outer ear canal infection can rarely develop after ear irrigation, patients should come back if symptoms such as pain, itching or discharge appear within a few days of the procedure.
Frequently Asked Questions
Is having no earwax at all a good thing? No; a complete absence of earwax means the ear canal is left without its protective barrier, and this can make the canal more prone to dryness, itching and infection.
Why is using cotton swabs harmful? Instead of bringing the earwax out, a cotton swab pushes it deep into the ear canal towards the eardrum, making plug formation and eardrum damage more likely.
What happens if earwax is never cleaned? In healthy ears earwax is expelled on its own; however, in people in whom it accumulates, reduced hearing, fullness and, over time, the risk of infection can increase.
Can I dissolve a wax plug myself at home using drops? Softening drops may help with mild build-up, but for dense plugs and in cases where the health of the eardrum is not known, professional cleaning is safer.
Is ear cleaning painful? The methods used are usually painless; slight pressure or sound may be felt during the procedure.
How often should I have my ears cleaned? This depends on how much earwax the person produces and on the anatomy of their ear canal; for people who frequently develop plugs, check-ups at the intervals recommended by the physician are sufficient.
When should I use softening drops? They are usually used for a few days on the physician’s advice before professional cleaning, to soften hard, dense plugs; continuous and unsupervised use is not recommended.
For the summary:
Back to the short articleThis article is for general information purposes only; please consult your physician for diagnosis and treatment.