As you can imagine, we see a LOT of earwax in a day!
Earwax is also known by the medical term cerumen. It is made up of a combination of sebum, sweat, and dead skin cells, and has some important functions. Earwax lubricates the ear and protects against bacteria, fungus, and water. It also serves to clean the ear.
Many patients come to us under the impression that earwax is gross and needs to be cleaned out of the ear canals. Actually, the majority of ears clean themselves out, and the earwax is the main tool!
The average ear canal is about an inch deep. The outer third has cartilage under the skin, and moves a little with head, neck, and jaw movement. Cerumen is generated by the glands in this outer portion of the ear. The inner two-thirds of the ear canal is surrounded by very dense bone, and does not produce earwax.
The skin of the ear canal actually grows in concentric circles from the tympanic membrane (ear drum) outward. As the head and jaw move during day-to-day life, the skin and earwax moves outward very gradually. Most people will find their ear canals to be self-cleaning, and don’t require any more than cleaning the outer ear and opening of the canal when washing their face.
Often when people get into earwax trouble, it comes from putting things into the ear canals. Cotton swabs, hair pins, and As-Seen-On-TV tools often push earwax deeper into the ear canal onto the skin that is less able to move and self-clean.
In my earlier professional years in a medical ENT setting, I saw the truly worst case scenarios, where a Qtip was accidentally pushed through the eardrum causing severe long term damage. Stick to a washcloth over a finger to clean as deep as is needed.
I also get questions about ear candling. Ear candling was created as a relaxation therapy, and not for ear wax removal. The FDA strongly discourages ear candling due to the obvious risks and lack of benefit. In multiple trials, my colleagues have taken pictures and video of occluded (blocked) ear canals before and after ear candling. Usually there is no change, occasionally the ear blockage actually gets worse! (Message us, we will send you the video if you don’t believe us!)
While most ears are usually quite successful at self-cleaning, our bodies don’t always perform as planned all of the time. Sometimes our ears need a little help to reset from a wax blockage. Folks who have things in their ear canals regularly, like hearing aid wearers, musicians with in-ear-monitors, or those who need to wear earplugs for work, can find that self-cleaning system has some interference and may need help. We also know that individuals in skilled nursing have an extremely high rate of ear wax blockage – likely due to reduced body movement. There is no research on ear wax blockages in individuals who live independently or with home care but have limited mobility, but given what we know, it is wise to have the ears checked often.
In our office we help with ear wax removal in one of 3 ways:
- Over-the-counter supplies and advice
- In-office removal by an audiologist
- Referral to ENT for deep wax or unhealthy looking ears
We carry three types of wax removal kits for sale in our office, including a super-power wax softening that is not available in regular stores and pharmacies.
In office removal can be completed with “irrigation” by rinsing the ear out with a safe amount and pressure of clean water, or “manually” by removing with tools. If at any point we do not feel that we can safely complete the task, we will discuss referral options for and Ear, Nose, and Throat specialist.
Wax removal by an audiologist is almost always an out-of-pocket cost. This can come as a surprise, to some patients. We like to make sure that it is clear up front. We are happy to submit to your insurance for reimbursement, but because our experience shows little-to-no coverage, we do ask patients to pay up front.
And remember, You don’t need to apologize for your earwax! We are used to it!