Conditions: Earwax (cerumen)
This page describes earwax (cerumen), its purpose, and some problems that may arise from it. Click here for information on the treatment of problematic earwax.
Earwax (cerumen) is produced by the skin of the outer 2/3 of the ear canal. Click to Enlarge.
About earwax:
Earwax, known medically as cerumen, is normal material produced in the outer aspect of the ear canal to help clean, waterproof, and prevent infection in the ear. Cerumen consists of thick oils produced by glands in the outer ear canal skin mixed with dead skin cells. Hair and other matter may mix in with the wax.
Normally, earwax falls out of the ear canal by a self-cleaning mechanism assisted by jaw movement.
This normal self=cleaning mechanism allows the majority of people to avoid problems associated with wax by simply ignoring it. In a minority of people, this self-cleaning mechanism may fail, leading to an accumulation of earwax and various problems. Earwax should be left alone unless it is blocking your doctor’s view of the ear canal and eardrum, or causing symptoms.
Who needs to proactively manage earwax?
These groups are more likely to need proactive management of earwax:
People with a very small ear canal
People who wear a hearing aid
People who have had repeated problems from earwax impaction not incurred from use of q-tips or other foreign objects
Potential Problems from Earwax:
Hearing loss - A complete or near complete wax blockage of the ear canal or wax in contact with the eardrum may cause hearing loss. Do not assume that hearing loss is due to wax; seek medical evaluation to rule out a dangerous or time-sensitive condition.
Tinnitus (noise) - Earwax causing hearing loss may reveal or unmask tinnitus.
Itchiness
Feeling of ear fullness - Seek medical evaluation if you have symptoms of hearing loss, ear fullness to rule out a more serious condition.
Infection - Cerumen may create a dam that retains moisture in the ear canal, predisposing to infection. Also, ear infections infections including otitis media (infected fluid behind the eardrum), otitis externa (infection of the ear canal), and sudden inner ear hearing loss can all present like cerumen impaction.
Odor
Discharge
Interference with medical ear examination or hearing testing
Note: all of these problems can be made worse by misguided efforts to remove wax.
These problems are expanded below.
Potential for wax causing hearing loss:
If ear wax makes a complete seal of the ear canal, it will act as an earplug, dampening external sound waves from reaching the tympanic membrane. Surprisingly, perhaps, if even a small gap or air passageway exists past the wax, sound intensity is not meaningfully decreased.
If wax gets pushed onto the surface of the eardrum (which is usually the result of using a q-tip or something similar), this mass effect can cause significant hearing loss until the wax is removed.
Potential for wax to cause tinnitus (noise in the ear):
Many people have a degree of tinnitus that is audible when they are in quiet environments. Hearing loss, such as that from a wax as described above, may dampen the actual sound in a room, making the pre-existent tinnitus more apparent.
Potential for wax to cause an infection of the ear canal (otitis externa):
Cerumen can contribute to the development of an infection of the ear canal (otitis externa). Excessive accumulation of cerumen in the ear canal can create a moist environment ideal for bacterial or fungal growth, leading to inflammation and infection of the ear canal. When cerumen blocks the ear canal, it can trap water, bacteria, and debris, further exacerbating the risk of developing otitis externa.
potential for wax to cause itchiness:
Cerumen can cause itchiness in the ear canal, especially if a loose piece of wax is shifting.
ear Fullness
A feeling of fullness in the ear may be the result of a significant accumulation of wax, but fullness may also result from other ear conditions, mainly Eustachian tube dysfunction, and also otitis media with effusion and chronic otitis media.
Infection
Ear wax uncommonly causes infection. Also, infection may sometimes present in a way that mimics earwax blocking the ear canal.
Cough
Contact of an object on the skin of the ear canal can stimulate a cough in a response called Arnold’s reflex. This reflex may uncommonly be triggered by earwax.
Discharge
Wax normally falls out of the ear canal. While some people make dry, flaky wax and others make a more oily wax, the quality of any material coming out of the ear canal usually allows a person to differentiate wax from pus.
Interference with medical ear examination or hearing testing
Often, adequate visualization of the eardrum may be achieved by a healthcare provider despite some wax. When an accumulation of wax prevents sufficient inspection of the eardrum or may affect results of a hearing test, the wax may be removed.
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