Ear wax

Types of Earwax

Earwax (also known as cerumen) is produced in the ear canal mainly in outer third cartilaginous portion. Earwax is composed of a mixture of viscous secretions from sebaceous glands and less-viscous ones from modified apocrine sweat glands.

There are two distinct types of earwax that is genetically determined: the wet type, which is dominant, and the dry type, which is recessive. Asians and Native Americans are more likely to have the dry type of cerumen (grey and flaky), whereas Caucasians and Africans are more likely to have the wet type (honey-brown to dark-brown and moist). If one had the desire to taste it, one would find that it has a bitter flavour.

From these two basic types, there is a continuum of varying consistency and appearance.

The difference in cerumen type has been tracked to a single base change in a gene known as “ATP-binding cassette C11 gene.” In addition to affecting cerumen type, this mutation also affects sweat production. Furthermore, researchers have found that if the earwax is particularly foul smelling and a person’s sweat is similarly malodorous, that this is linked to an increased risk in breast cancer!

What is the Function of Earwax?

Earwax actually provides several important functions for smooth functioning. It prevents infections (otitis externa) as well as provides lubrication of the ear canal skin. Of course, when there is excessive earwax, that’s no good either, but having NO earwax is just as bad.

How is Earwax Cleaned?

Cleaning depends on age as well as whether there is a hole in the eardrum or a tube present.

  • Physical removal using a curette (right) or suction (below) under the microscope or otoscope is most common
  • If the patient is a child and unable to tolerate removal and removal absolutely necessary, the child can be put under anesthesia.
  • In some primary care offices, flushing with water is performed (this is not done typically in ENT offices). There are over-the-counter ear flushing kits available as well.
  • ONLY IF there is no tube or eardrum perforation, one can use over-the-counter liquid earwax removal kits/drops (some listed below).
    • Olive oil, almond oil, mineral oil, baby oil, and various other organic liquids (glycerol)
    • Carbamide peroxide (6.5%) and glycerine (Debrox)
    • A solution of sodium bicarbonate in water
    • Cerumol (arachis oil, turpentine and dichlorobenzene)
    • Cerumenex (Triethanolamine, polypeptides and oleate-condensate)
    • Urea, hydrogen peroxide, and glycerine (under different brand names)
    • Liquid Colace
      (a detergent) which is NO longer recommended

It is most helpful to use a liquid earwax removal (assuming no eardrum perforation or tube) for at least 1 week prior to seeing your physician as it does make it MUCH easier to remove in the office.

However, research has shown that plain old water (yes… plain old H2O) offers the most superior earwax dissolving ability AND is safe to use in setting where there’s a hole in the eardrum.

Often, people have tried ear candling to remove earwax. Our office discourages this form of removal as every month or so, we have seen patients in our office with 1st degree burns to the ear canal. Unfortunately, in this scenario, there’s not much one can do beyond prescribing a steroid antibiotic ear drop and give it time.
Also, ear candling does not actually remove any earwax. The debris seen within the candle after use is actually pieces of the ear candle itself that falls into the cavity as it burns (test this out by using an ear candle in an empty cup).

What about Q-Tips?

For patients with the wet or flaky type of earwax, Q-tips are OK to use as long as minimal pressure is applied and not inserted too deeply (about 1cm or just the cotton part of the q-tip). Aggressive Q-tip use may cause the ear canal skin to become scratched and even infected, a situation known as otitis externa or swimmer’s ear. Deep insertion may tear a hole in the eardrum as well.

For individuals with the other types of earwax (tarry, nuggets), Q-tip use generally pushes and packs the earwax deep in the ear canal which eventually will cause ear pain and hearing loss. As such, Q-tip use is discouraged in these patients. Earwax removal in this situation is quite uncomfortable.