Earwax

Causes Of Earwax Buildup

Earwax is a sticky substance that is made up of dead skin cells, and sweat mixed with dirt, and contains oil. The sweat glands in the skin of the human external auditory canal, together with sebaceous glands, produce ear wax. It has lubricating and self-cleaning agents with protective, emollient, and bactericidal properties. 

Ear wax build-up can be due to:

• Failure to self-clear because of slow skin migration

• Putting small things like cotton buds, hairpins, headphones etc. in your ears. These objects can push the wax further down the ear canal.

Types Of Earwax Buildup

Mostly everyone’s ears produce earwax. However, its composition varies from person to person.

The 2 primary types of ear wax are wet and dry. Apart from these, here is a guide to different types of earwax:

• Yellow and soft earwax: This type of ear wax is a sign of healthy ear wax production. It is soft in consistency. It is new wax and doesn’t harden too much before it falls out from the ear.

• Pale and flaky earwax: It is also a sign of a self-cleaning mechanism of your ear. This type of wax easily falls out of the ear.

• Brown and firm earwax: Brownish or darker color earwax is a sign of older and sometimes harder ear wax. This could be a sign of ear impaction.

• Smelly ear wax: Smelly ear wax could be an early sign of any ear infection that might need a doctor’s intervention.

• Liquid or runny earwax: It is a form of wet earwax that usually occurs after swimming or diving. However, sometimes it can occur due to other middle ear infections or ruptured eardrums. 

• Blood-tinged earwax: If you find blood in your earwax, it's a sign of some injury to the ear canal. 

Is the color of your ear wax telling you something?

The color and consistency of your earwax can also vary depending on your environment and diet. Take care of your ears like any other part of your body.
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Symptoms Of Earwax Buildup

Earwax acts as a natural barrier that prevents bacteria and dirt from entering the innermost parts of the ears. But, if it builds up, it can cause severe ear pain and infections by irritating your ears wall and preventing you from hearing well. Earwax build-up 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

• Earpain

• 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.
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Risk factors Of Earwax Buildup

• Anatomical deformities like 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 like Sjogren’s syndrome and Lupus.

• Individuals with a gene variant -ABCC11 in their DNA

• Use cotton buds to clear the earwax.

Diagnosis Of Earwax Buildup

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 enquire 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 the outer, middle, and inner ear, ear canal, and tympanic membrane (eardrum) with an otoscope (a medical equipment that shines a beam of light for visual examination of the eardrum and the passage of the outer ear). 

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

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

Specialist To Treat

Specialists that can help to treat earwax impaction include:

• General physicians

• ENT specialists

• Pediatricians (in the case of children)

Otolaryngologists also known as ENT specialists diagnose and treat conditions of the interconnected head, nose, and throat systems.

When to see a doctor?

Consult an ENT specialist immediately, if you notice the following symptoms:

• Fever

• Prolonged earache for more than a week

• A foul odor from your ear

• Fluid coming out of your ear 

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Prevention of Earwax Buildup

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 ear wax cleaning, as it may push the wax more inside and irritate the ear wall, leading to serious infections.

• Use earplugs while taking showers, or while swimming. It will help you to prevent infection by blocking the entry of moisture or water droplets.

• Always dry your outer ear by gently cleaning it with a cotton swab. It will help you to avoid any trapping of water or moisture inside the ear canal.

• Use OTC ear drops to soften and remove ear wax if you have a history of producing excessive earwax.

• Do not irrigate your ears frequently as this can inflame the ear canal and causes pain, or ear infection.

• Avoid ear candling hasn't been proven to be safe or effective, and can be dangerous.

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Treatment Of Earwax Buildup

Earwax blockage can be treated or removed in several ways. 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 with water. In some cases, your doctor may use saline solution in place of warm water. Finally, your doctor can check and remove the 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 anatomic abnormalities of the ear canal(birth defect).

2. Microsuction technique

Removal of impacted earwax requires an instrument for visualization such as an otoscope, headlamp, or binocular microscope, and for removal, a micro-suction device along with 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 present to clear earwax blockages. These preparations are also known as cerumenolytics (solutions to dissolve wax) and are commonly used are:

• Hydrogen peroxide

• Sodium bicarbonate 

• Carbamide peroxide

You can use some natural cerumenolytic solutions in the ear canal. These solutions include:

• Mineral oil

• Baby oil

• Glycerin

• Saline solution

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 and it's normal. This is 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 wax in dissolved form. Clean the outer part of the ear with a small piece of cotton.

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Home care For Earwax Buildup

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

• Chewing gum: If your ears are plugged or you have a feeling of fullness even after the removal of earwax. Chewing gum can relieve the pressure in the middle ear. If this doesn’t work, try to take deep breaths and blow out of your nose gently while pinching your nostrils closed.

• Honey (Shahad): Sometimes earwax blockages cause cough. To treat a cough at home, the best remedy is honey due to its mucolytic property. You can eat a spoonful of honey or mix it with warm water.

• Ginger (Adrak): It has natural anti-inflammatory properties that can help soothe a sore throat or cough. Applying ginger juice around the outer ear canal can relieve ear pains.

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• Olive oil: A few drops of olive oil into the affected ear can act as a lubricant and helps in getting rid of the infection as well as the blockages due to earwax.

• Garlic (Lehsun): It has both antibiotic and analgesic properties. Warm a few cloves of garlic in eucalyptus oil. Cool, filter the oil, and apply a few drops of this garlic oil around the outer parts of the affected ear.

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Complications Of Earwax Buildup

If excessive earwax is not removed, it may turn the symptoms of earwax blockage worse. 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 due to loud music, head injury, or any foreign entity in the ear.

• Middle-ear infection: Some people develop an inflammation in the ear canal and later ear infection after irrigation. As earwax works as a physical barrier and prevents the entry of bugs, dirt, etc into the ear. Therefore, removing it completely can cause middle ear infections. Mostly mild ones are cleared up on their own but in some cases, ear drops(antibiotics) are needed to treat the infection.

• External-ear infection (swimmer’s ear): This doesn’t mean that you are a regular swimmer. It occurs when moisture or water is trapped in the ear canal causing pain and a feeling of something being stuck inside the ear. This can be caused by taking showers, washing hair, or being in a moist or humid environment.