The skin which lines the ear canal moves outwards at the rate of 33mm a year and this natural movement encourages the wax to fall out of the ear in flakes or small crusts from time to time.
The amount of wax produced varies from person to person dependent on their lifestyle, diet, age, skin condition, anxiety levels and anatomy of the ear canal.
There are two distinct forms of earwax: 'wet' and 'dry'. The type of wax a person has is probably genetically determined, and may vary by ethnicity. Most people in Britain have the 'wet' type of earwax.
You are more likely to have excess wax if you have a high fat diet, if you are elderly or of an anxious disposition, if you have narrow ear canals, if your parents had excess wax problems, or if you try to remove wax using an object in the ear, such as a cotton bud (Roeser & Ballachandar 1997). As part of the ageing process the glands secrete less sebum (oily secretion), often causing wax to be drier and harder. This, together with the reduction in movement of the ear canal skin, means that older people are more likely to experience wax blockage.
Does earwax need to be removed?
Healthy ears produce wax and it does not need to be removed unless it has caused dulled hearing, itchiness or discomfort, or the wax is obstructing the ear canal and a doctor or nurse is unable to examine the ear. The doctor or nurse will examine the ear with an otoscope, which is a bright white light with a very small end which rests at the entrance of the ear canal enabling the clinician to see the ear canal skin, any excess wax formation and the eardrum at the end of the ear canal. It is often possible to recognise some bones in the middle ear space behind the eardrum.
If you produce excessive earwax the problem can be prevented by a regular ear check-up with a nurse trained in ear health, who can just gently lift out excess wax with a little ring and leave minimal healthy wax to protect the ear canal skin. The nurse will wear a headlight so that there is a clear vision of the ear canal. This kind of ear check-up is a bit like a check-up you might have at the dentist's.
Which are the best drops to use for earwax removal?
There are many different types of drops sold over-the-counter but these may irritate the skin and cause soreness in some people. They should not be used where there is a perforated eardrum or previous otitis externa (outer ear infection). It is important to remember that the ear canal into which you are putting the drops may already be dry or itchy, and the skin lining may be thinning with age or may even have an infection in it and not just wax. There is a new seawater ear spray on the market which is said to loosen hard wax in the ear canal but every person is an individual and this may also cause discomfort in some ears.
Olive oil is a gentle lubricant which lubricates both the skin and the wax plug so making it easier for the doctor or nurse to remove and causes no discomfort (unless there is a rare allergy to oil). If you are not sure which wax-removing drops are best for your skin visit your doctor or nurse to ask. They will be able to tell you what they can see in your ear and help you make the right choice.
Some older people have a problem with wax removal because they produce less oily substance so the wax becomes dry and hard (Roeser & Ballachanda 1997). If they also produce excess wax, this will become a recurring problem requiring irrigation (syringing). For people with this problem, one drop of oil inserted into each ear once a week maintains the gentle lubrication of both the skin and the wax, which encourages natural wax movement out of the ear canal. This also helps the doctor or nurse to irrigate the ear more quickly, should this become necessary.
What is the best way to use ear drops?
Using antibiotic/anti-inflammatory ear drops
- Tilt the head so that the infected ear is uppermost
- Pull the pinna (outer ear) backwards and upwards (just backwards in children)
- Drop the prescribed amount of drops into the affected ear and massage the tragus (the skin just in front of the entrance to the ear canal)
- Return the head to the upright position and wipe away any excess drops
- Do not put cotton wool into the ear after using drops as it will absorb the drops and they will be less effective
- Repeat procedure with the other ear if required.
Using olive oil drops
- Lie down on your side with the ear requiring drops facing upwards
- Pull the pinna (outer ear) backwards and upwards (just backwards in children)
- Drop 2 or 3 drops of oil, at room temperature, into the ear canal and then massage the tragus (the skin just in front of the entrance to the ear canal) - this enables the oil to run down the ear canal more easily
- Stay lying down for 5-10 minutes and then get up and wipe away any excess oil with a tissue
- DO NOT put cotton wool in the ear following the drops as this absorbs the oil
- Repeat the procedure with the opposite ear if required.
This procedure repeated for two or three nights before attending an appointment for wax removal is usually sufficient to enable the doctor or nurse to remove the wax easily.
Other wax removal drops
Many of the drops on the market which claim to remove wax do not live up to their advertising, and many irritate the skin in the ear. You should only use wax removal drops that have been prescribed by your doctor. If you have been prescribed such drops, make sure your doctor or pharmacist explains how to use them properly.
What is ear irrigation (syringing)?
This is the method of washing wax out of the ear canal once it is soft enough.
Usually a nurse will perform this task. S/he wears a headlight and sits down next to the patient so that s/he is able to see into the ear canal while carrying out the irrigation. Warm water is placed into the reservoir of an electronic irrigator and a little white tip (a clean one for each patient) is placed on the end of the handle. It is through this tip that the water passes into the ear canal. The irrigator is turned on in advance to allow the water to run through the system and be warm on presentation to the patient. The patient holds a container below the ear to be irrigated, at the level of the neck. The little white tip is placed at the entrance to the ear canal and aimed towards the top of the back wall of the canal. A short flow of water enters the ear and the patient is asked if it is satisfactory. This is then repeated and if there are no problems or discomfort the water flow is continued along the ear canal wall.
The action of the water flowing behind the wax will bring it out into the container. The doctor or nurse then inspects the ear canal to check that all the wax has been removed. If it has been, a probe covered with soft cotton wool is used to gently dry out the ear canal. This reduces the chances of an ear infection following the irrigation.
Can I get an infection following ear irrigation?
An infection is more likely if a person has previously tried to clean their ear with a cotton bud, as this may have damaged the skin lining of the ear canal. If water is left in the ear, this may cause an infection to occur where the skin has been damaged with the cotton bud. If the water is too cool it can sometimes cause the patient to feel a little dizzy but this soon settles. The patient should never experience any pain but some people may feel a little discomfort. If the ear is itchy and uncomfortable after a few days it may be that an infection has occurred which will require an appointment with the doctor so that it can be treated with drops.
Is it safe for everyone to have ear irrigation?
Earwax cannot be washed out of the ear canal where the person has:
- had previous ear surgery;
- had problems with previous ear irrigations;
- had recent middle ear pain or infection
- a perforated ear drum.
In cases where ear irrigation is not desirable or safe practice, it is frequently possible for a nurse who has been trained in the procedure to lift the wax out with special instruments
When neither of these ways is possible the wax can be sucked out in a hospital ENT department. A specialist doctor or nurse will use a microscope to look into the ear and a small suction tube to remove the wax. This procedure can be noisy and uncomfortable, depending on the position of the wax in the ear canal. If this method of removal is required, the GP will refer the patient, who must then wait for a hospital appointment.
Ear irrigation is only one way to remove wax from the ear. Ear specialist nurses can often clear ears without using water irrigation. In very rare cases, earwax can become so impacted that it must be removed by an ENT surgeon.
Does earwax prevent hearing aids performing efficiently?
80 per cent of hearing aid repairs are a result of excess wax production (Oliveira 1997). Some of the small 'in the ear' hearing aids have a tiny white ring (wax/cerumen filter) which fits into the microphone inlet. This is only a few tenths of a millimetre wide and helps prevent earwax from entering the instrument. These filters must be fitted correctly or they can fall into the ear canal and cause irritation, needing to be removed by a nurse or doctor. If the inlet of the aid is blocked by earwax, the volume may be reduced or even cut-off all together and a high pitched whistling noise frequently occurs.
For more information on earwax, please get in touch with our Advisory Service.