Earwax causes, symptoms, diagnosis and treatment

Earwax is a yellow or brown colored sticky substance that is naturally produced by the glands in the ear. The purpose of this earwax is to stop the bacteria and other foreign bodies to reach the inner part of the ear. Thus, earwax tends to be a natural barrier in the ear. But, on the other hand, the production of too much earwax can be really troublesome. Before we can move on to know the ways of removal of earwax, we need to know some basics here.

Earwax: Production, functions and abnormalities

Human ear is one of the wonders of nature. One would be amazed to know that nature has fit one of the best hearing devices into a small cavity within a bone. Not only is the inner part of the ear a complicated structure but is also quite intricate and fragile. If anything foreign gets access to the inner part of the ear, results can be extremely damaging. But nature has a solution for every problem. That’s why nature has blessed our ear with a wax secreting assembly.

This assembly makes sure to secrete adequate amount of wax so that anything foreign can’t get entry into the inner part of the ear- the exact benefits of earwax are discussed later. Sweat and sebaceous glands are two most commonly found glands on human skin.

Sweat glands produce sweat that keep the body moist and keeps it safe from the harsh forces of nature. Sebaceous glands, on the other hand, secrete oily secretions that keep the skin sticky. Moreover, these oily secretions keep the pH of the skin quite low. That’s helpful because bacteria can’t grow on a low pH. Similar glands are present inside the ear as well. But minor changes are present in these glands as per the requirements of ear.

Sweat glands are same in the ear canal as on any other part of the body. But the sebaceous glands are a little modified in their structure and functioning. These modified sebaceous glands are called ceruminous glands. Ceruminous glands produce secretions that are rich in lipids (types of fats). Both these glands first open into the cavities of hair follicles and from there the wax comes to the surface of outer ear canal.

So it’s the combination of secretion of sweat and sebaceous glands that we call earwax.

You might think of earwax as a useless thing and most of us want to get rid of this ugly looking wax as soon as possible. But you would be amazed to know that most of the ENT specialists ask their patients to avoid unnecessary cleaning of their ear.

But what makes the earwax so important?

Here is the answer to your question:

• As mentioned before, earwax prevents any foreign object like water, insects etc. from reaching the deeper parts of ear.
• Earwax is responsible for creating an acidic pH in the outer parts of the ear. Outer part of ear being otherwise inaccessible provides an ideal location for bacteria and fungus to grow. Decrease in pH achieved through earwax keeps the growth of fungus and bacteria under check and this way ear escapes variety of bacterial and fungal infections.
• This might be interesting for you to know that earwax has got a repellant odor for mosquitoes and other insects.
• Earwax collects debris like dead cells of ear canal, foreign materials, dust etc. and takes them away with itself as it moves out of the ear. This way earwax actually helps to keep the inner part of the ear clean.
• Lastly, presence of earwax is responsible for lubricating the outer ear canal. This is important because this keeps the ear moist and prevents it from cracking. This way earwax prevents itching and wounds to develop in the ear canal.

Nature has also provided our ear with different mechanisms to keep the level of earwax within normal limits. Normally the total amount of wax produced and total amount expelled from the ear is kept under a perfect balance. But sometimes this balance is thrown out of order.

Normally the movements of jaw (as during chewing) are responsible for expelling most of the wax from ear canal.

But the amount of wax in the ear canal can increase due to two reasons: either due to increased production by sweat and sebaceous glands or decreased removal from the ear canal.

Whatever the reason might be, result will be accumulation of earwax in the ear canal and plugging of ear canal.

Depending on the character of earwax, it can be further divided into type types: soft earwax and hard earwax.

Soft earwax, as the name shows, is soft and easy to remove. Moreover, it is not associated with severe pain. Hard wax on the other hand is extremely hard, difficult to remove and causes severe pain. Hard wax might also be blood tinged. This happens when one continuously tries to clean the ear and damages the ear canal instead.

What are the signs and symptoms of earwax?

Earwax might not sound much to you but this situation can be extremely painful and irritating if not dealt with timely.

The symptoms (complaints that a patients tells to the doctors) can vary greatly depending on the severity of situation. Some important symptoms of earwax build up are as follows:

• Pain is the most important complaint of patients with earwax buildup. The pain is most severe in the outer part of the ear and in the area behind the ear. The severity of pain, again, depends on the type of earwax. Presence of hard wax is associated with significantly more pain as compared to soft wax.
• The movements of jaw become very painful. This is because jaw movements put pressure on the ear canal. The patient usually complaints that the pain aggravate while he chews and swallows hard food.
• The outer part of ear (pinna) becomes painful to touch or move.
• Another important complaint that patients usually present with is intense itching of the outer ear. The itching is quite intense and any attempt to clean the wax might push it further inward.
• Sometimes the patients present with gradual decrease in hearing leading to partial or complete loss of hearing. The degree of loss of hearing depends on how much the earwax has filled the ear. If the earwax has filled the ear partially then the loss of hearing might be partial. If the earwax fully obliterates the ear canal then the loss of hearing will be complete. This loss of hearing might occurs due to decrease in conduction of sounds waves from the ear canal to the ear drum.
• The patient also complains of a sense of fullness. The patient would describe it as if something has filled his ear and he can’t take it out.
• Sometimes the wax starts to irritate the nerves of ear canal. This is when the patients start to develop the symptoms like dizziness, loss of balance, nausea and vomiting.
• The patient might also complain of ringing sensation in his ears. Signs (the features that doctor deduce upon history taking and examination) are as follows:
• Upon examination of ear the doctor might observe that the pinna is quite red, swollen and painful to touch. The doctor might also observe redness and swelling in the area behind the ear.
• Upon the retraction of ear, the doctor might observe redness and inflammation of ear canal.
• There might also be scratches in ear canal. This happens when the patient tries to take out the wax forcefully by the means of wicks, keys or other objects.
• Upon thorough examination the doctor might also observe a substance filling the ear. This substance is wax. It might be yellow or might be red due to the presence of blood.

How is earwax diagnosed?

The diagnosis of earwax is solely based on history taking and physical examination. Imaging techniques have no value here.

The doctor will start with taking history. He will ask the patient questions like:

• What is your complaint?
• Have the movements of your jaw become painful lately?
• Is your pinna painful to touch or move?
• Are you experiencing loss of hearing? If yes then how will you grade it?
• Do you feel nauseate sometimes?
• Have you felt dizzy lately?
• Do hear sound in your ear?
• Do you feel as if your ear is full?
• Is there any discharge from your ear? (This question will help the doctor differentiate problem of external ear from middle ear).

The second step in the diagnosis of earwax buildup is proper physical examination of the patient.

The doctor will first explain procedure to the patient and will take permission for performing the procedure.

After that the doctor will set his head mirror such that the ear is illuminated well. The doctor will retract the pinna of ear upwards and backwards (the outer ear canal is S shaped structure and retracting the pinna upwards and backwards help in straightening the ear canal. This way the deeper portions of the ear can be visualized).

The earwax can be seen plugging the ear canal through this procedure alone. Normally, in an unplugged ear the doctor can appreciate deeper parts of the ear i.e. he can see white colored ear drum.

But if something is obstructing the ear canal (such as earwax) then these structures become difficult to see.

If the doctor is having difficulties in visualizing the earwax then he has got two options: examination through otoscope or examination under microscope.

Otoscope is a funnel shaped instrument that can be inserted into the ear canal and deeper portions of the ear can be visualized in a better and magnified manner. If this method doesn’t work then the next option is to examine the patient’s ear under a microscope.

In this procedure the patient is made to lie down on a flat surface and microscope is used to visualize deeper portions of the ear.

Doctor can also perform other tests to confirm the diagnosis and assess the degree of damage done. These tests include:

• Tuning fork test: This test can help the doctor differentiate between earwax or conduction abnormalities from other problems of hearing associated with the damage to the inner portions of the ear.
• Fistula test: During this test the tragus of ear is pressed inwards forcefully and pressure is maintained for some time.

If the patient complaints of vertigo, nausea and imbalance then the complaints of vertigo are due to the damage to inner parts of ear instead of earwax. If the test is negative, the symptoms of vertigo are due to some other reason.

Natural ways or home remedies for earwax removal

Normally, the chewing movements of jaw help out to remove extra wax from the ear. But, sometimes, the ears become clogged with excessive earwax. The clogged wax gets harder with time and causes pain and itching in the ear.

You may be facing the same trouble. But do not worry; it is a very commonly faced ear problem. There are many ways, natural and medical, that can provide you relief from painful earwax within no time.

Here are given some treatment options available for getting rid of excessive earwax:

Removing the earwax at home is not a big deal. You may be fond of home remedies as they are not only inexpensive, but they also save you from paying a visit to your doctor.

A lot of home remedies are used to get rid of clogged ears. But you have to be cautious while trying such natural ways of treatment. Do not try these home remedies if you are having any sort of ear infection or ear discharge.

Hydrogen peroxide

Hydrogen peroxide is one of the best ways to wash out the extra earwax at home. All you need to do is to purchase a 3% hydrogen peroxide solution and a disposable syringe. Take small amount of hydrogen peroxide and mix it with equal amount of water. The water should be at room temperature, neither hot nor cold because it can worsen the ear ache and itching.

Now take the syringe and fill it with the solution or mixture of hydrogen peroxide and water. Tilt your head to sideways and pour a few drops of hydrogen peroxide solution, slowly, with the help of syringe in the affected ear (its better if you ask someone do it for you). Stay in the same posture for a few minutes until the solution drops are absorbed by the earwax. You might hear some bubbling sound in your ear after pouring the solution which indicates that hydrogen peroxide is working and dissolving the earwax. After a few minutes, tilt your head to the opposite side and let the extra solution come out.

Repeat this remedy 2 to 3 times daily until the earwax dissolves. Never use concentrated hydrogen solution as it can damage your ear. Stop the use of this remedy if the wax does not melt within 3-4 days.

Olive oil

One of the safest ways to soften the earwax is to use olive oil. Take a small amount of olive oil and warm it slightly. Now tilt your head and pour a few drops of this lukewarm olive oil with the help of dropper into the affected ear. Wait for at least for 10 minutes until the oil settles down in your ear. After waiting for a few minutes move your head back and wipe away the extra oil with a cotton ball. Olive oil lubricates the ear and helps to soften the stubborn hard earwax. Continuing this remedy for 2-3 days will help in melting the wax. You can also use baby oil in place of olive oil.

Tea tree oil

Like olive oil, tea tree oil is also used for lubricating the earwax. Sometimes, the earwax sticks to the walls of the ear canal, leading to pain when you try to remove it. The piling of too much wax in the ear makes your ear more prone to infections by promoting the growth of bacteria in it. But, using tea tree oil is the best way to stop this from happening. Tea tree oil is known for its antiseptic nature. It helps in fighting against the bacteria or fungal infections in the ear. Pouring a few drops of tea tree oil, for consecutive 3-4 days, will not only soften the earwax, but will also aid in suppressing the pain and inflammation associated with earwax.

Garlic

The anti inflammatory and antiseptic role of garlic makes it favorite for use in a number of home remedies. We cannot forget the significance of garlic while talking about the ways to get rid of excessive earwax build up. Now the thing is how can you use a piece of garlic for removing the earwax?

Simply, take a saucepan and add small amount of olive oil or coconut oil in it. Now take 2 cloves of garlic and crush them properly. Add these freshly crushed garlic cloves into the oil. Heat this mixture until it starts boiling. When the mixture boils, take it off the flame and let it cool down to the room temperature. After cooling the mixture, strain it and put the oil in a glass bottle. Add 2-3 drops of this oil in the affected ear, at night, before going to sleep. Using this garlic essence containing oil for a few consecutive nights will effectively melt the earwax. Apart from this, the antiseptic nature of garlic will protect your ears from getting any sort of infection.

Warm water

Another way to dislodge excessive earwax is to irrigate your ears with lukewarm water. Take a cup of lukewarm water and add to it one teaspoon of table salt. Mix it till the salt dissolves. Now take a syringe and fill it with this salt water. Stand on the wash basin and tilt your head in such a way that affected ear comes up. Carefully insert the tip of the syringe into the ear. You need to be cautious as syringe must not penetrate deeply into the ear canal.

Once you insert the tip of the syringe into the ear, press the bulb of syringe and gently squirt the water. Injecting water stream with force or pressure will help in separating the wax from ear walls. Keep your head in the fixed position to give some time to the salt water solution to dissolve the earwax.

After 5-10 minutes, tilt your head in the opposite direction so that the affected ear comes down. This will assist in pouring out the dislodged wax from the ear. Once the wax is removed, repeat the same method with plain warm water to remove the extra salt. After being done with it, dry out the ear carefully with the help of a cotton swab.

Apple cider vinegar and alcohol

Mix an equal portion of apple cider vinegar and alcohol. Lie down on your side, comfortably. Take a dropper and fill it with the mixture of apple cider vinegar and alcohol. Now, stretch your ear lobe in an upwards and backward direction. This widens the ear canal and helps in easy instilling of vinegar alcohol mixture in the ear. Carefully instill few drops of this solution into the ear by using a dropper. Keep lying in the same posture and let the solution reach the area of hard wax.

Do not move your head and give some time for the solution to work. You may feel a warm sensation of alcohol in the ear. This may be annoying, but you will have to ignore it. After resting for 10 minutes, tilt the head to the other side to let the extra fluid drain out. You can repeat this remedy until your ear becomes unclogged. Using alcohol and vinegar will effectively melt the wax within no time. The molten wax will come out on its own. On the other hand, the alcohol will keep your ear dry and will prevent the bacteria from growing inside the ear.

Glycerin

Glycerin is an excellent lubricant and moisturizer. Earwax causes problem only when it loses its moisture and becomes hard. When you try to remove such hard wax, you actually make it worse. This hard wax can cause pressure on your ear drum. So, if you attempt to remove such wax, it is possible that you may injure your ear drum too. To save yourself from such trouble it is advised that you first melt this hard wax and then remove it afterwards.

Glycerin is the best way to liquefy such hard and dry wax. Glycerin moisturizes the hard wax and melts it gradually. Pour a few drops of glycerin into the affected ear, at bed time, and close it with a cotton plug. Leave it overnight. This will allow the glycerin to slowly lubricate and soften the wax. Repeating this remedy for 2-3 days will eventually melt out the painful wax. Once the wax softens, you can clean your ear by using a cotton swab.

Do not insert anything in your ear

The ear is a very delicate and sensitive part of your body. Just imagine what would you do without healthy ears? Many people misunderstand the concept of healthy ears. They think that cleaning their ears hard by using ear buds or Q tips will help keep their ears clean. This is totally a wrong idea.

Earwax is not a culprit. In fact, it helps to protect your ear from foreign particles, dust and bacteria. You should not try to remove the earwax until or unless it causes ear blockage or earache. Removing the earwax without any reason, may do more harm than good. You might have seen many who love or enjoy scratching their earwax with hair pins and other pointed objects. This is something you must avoid if you want your ears to be healthy.

Even the use of cotton ear buds for cleaning earwax is not advisable. You might think that by using ear buds you are plugging out the earwax, but in reality you are pushing it deep inside the ear. Inserting any pointed object in the ear can injure your ear canal and can perforate the ear drum, leading to swelling and severe pain in the ear. This makes your ear more prone to infections as well. So, if you are wise enough you will try to do such things for removing earwax. If the earwax is giving you trouble, you can use a number of other safe home remedies to get rid of this wax without doing any harm to your sensitive ears.

Medical treatment for earwax buildup

If all the home remedies fail to relieve the symptoms of ear blockage and pain due to earwax, then it is recommended to contact an ENT specialist. The doctor will do a complete examination of your ear and will then go for treatment plan according to his findings. The medical treatment for earwax build up is quite simple that does not involve any extensive medical procedures.

Here are some ways by which the doctor will try to remove the painful wax from your ears:

Ear drops

The first thing that your doctor will prescribe you is wax softening ear drops. These ear drops are easily available in the pharmacies and are very easy to use. The purpose of these drops is to gradually melt the hard and painful wax. These ear drops contain wax dissolving ingredients like carbamide phosphate, carbamide peroxide, glycerine, sodium bicarbonate, thriethanolamine, oleate condensate and Docusate. The ear drops of various brands may vary in their composition. These wax dissolving chemicals can effectively liquefy the stubborn wax that is difficult to remove with home remedies. Pour 3-4 drops of these agents into the affected ear twice or thrice a day. Continue doing it for 2-3 days till the earwax gets dissolved.

Use these ear drops at night, before sleeping, as it will give more time to the ear drops to melt the earwax. But it is advised that people having hole in the ear drum should avoid using these ear drops without consulting the doctor. In case of perforated ear drum, the ear drops will seep through the hole into the middle ear cavity. Accumulation of ear drops in the middle ear can lead to infections.

Irrigation and suction

This is a very simple procedure that just takes a few minutes. The doctor will ask you to lie in a supine position (face upwards) and tilt your head slightly. The procedure is done under the microscope as it helps in having a clear view of the inside of the ear. A special electrical irrigation tube is used to wash or irrigate the ear with solution of normal saline. With this instrument, the saline solution is propelled with force or pressure in the ear. This pressure will help in dislodging the earwax from the ear canal.

After irrigating the ear with normal saline, the suction tube is inserted into the ear to suck out the dissolved wax. If the patient complaints of pain during suction, the doctor will stop immediately because it means that the wax is hard and removing it forcefully with suction can cause damage to the ear drum. In such case, the doctor may ask the patient to continue using the wax softening ear drops for 3-4 days and then come back for irrigation.

Curette method

Sometimes, the doctor tries to remove the wax plug with the help of curette. Curette is a scoop shaped surgical instrument with a long handle. While observing under the microscope, the curette is inserted in the affected ear and the wax is taken out by clamping it with curette.

Use of analgesic medicines

When the wax become stony hard, it puts pressure on the ear drum and causes severe pain. To relief the earache, the doctor may prescribe you NSAIDs (non steroidal anti-inflammatory drugs) like ibuprofen and flurbiprofen. These NSAIDs will reduce the swelling and pain associated with earwax.