The Bane and Boon of Ear Wax

Contrary to popular belief, ear wax is not just the nasty, sticky stuff that accumulates in your ear that requires removal with a Q-tip! Ear wax actually has a very important purpose—to trap dust, microorganisms and other foreign particles, preventing them from entering and damaging your ear canal and ear drum. It also has lubricative properties that prevent the skin within the ear canal from drying out, itching and burning, and recent studies have found it to be effective in reducing the viability of a wide range of bacteria. However, even too much of a good thing can be bad!

Ear wax is not wax in the paraffin sense, but is a waxy oil secreted by the cerumen glands. Everyone makes ear wax, although some people make more than others. Actor Keanu Reeves can probably attest to this, as he was recently photographed leaving the Crown Bar in Los Angeles with a large chunk of earwax sticking out of his ear. In some people, this extra wax hardens within the ear canal and blocks the ear, causing pain, fullness, noise in the ear or even hearing loss. It is estimated that each year some 12 million people in the United States seek medical care for impacted ear wax.

The healthy ear cleans itself with a type of "conveyor belt" process. Tiny hairs in the ear canal, assisted by jaw movement, transport the wax, along with any dirt, dust, and particulate matter that it may have gathered, to the ear opening, where it falls out or is removed by washing. "Unfortunately, many people feel the need to manually ‘remove' cerumen from the ears," said Dr. Peter Roland, an ear specialist at the University of Texas Southwestern Medical Center at Dallas. "This can result in further impaction and other complications to the ear canal."

Dr. Roland recently chaired a panel that released new guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) designed to help health care professionals identify patients with impacted wax and treat them properly. The panel, comprised of specialists from otolaryngology, family medicine, internal medicine, audiology, pediatrics and nursing, reviewed scientific studies and expert opinions to create the guidelines. "The conclusion is that the mere presence of ear wax does not require anything," Dr. Roland said. The panel advises against the use of cotton swabs, oral jet irrigators and ear candling to remove wax. Instead they recommend letting it work its way out naturally, and if it doesn't, seeking help from your health care provider. Doctors use several methods to remove the wax, including using wax-dissolving agents such as water and saline, irrigation, or manual removal with special instruments or ear syringes.

There are no proven ways to prevent ear wax impaction, according to the guidelines. Some people have problems with ear wax throughout their lives, while many develop "problem wax" as they get older. As we age, the ear does not work as well, and health problems or hearing aids might make it harder for your ear to remove the wax on its own. For example, if you are 70 and wear hearing aids, you might want to visit your doctor every six to 12 months for routine cleaning. "The complications from cerumen impaction can be painful and ongoing, including infections and hearing loss," said Dr. Roland. "It is hoped that these guidelines will give clinicians the tools they need to spot an issue early and avoid serious outcomes."

The guidelines are published in the September issue of Otolaryngology-Head and Neck Surgery.