What Is Earwax (Cerumen)? What Is Earwax Impaction?

Date: Aug-13-2012Earwax, also known as cerumen, is a yellowish waxy material that is produced by the sebaceous gland in the ear canal inside the ear. Earwax lubricates, cleans and protects the lining of the ear canal by repelling water, trapping dirt and making sure insects, fungi and bacteria do not get through and harm the eardrum. The cerumen is slightly acidic and has antibacterial properties. If we had no earwax, the ear canal would become extremely dry, waterlogged and infected.

Earwax consists mainly of shed layers of skin - 60% of it is keratin, 12% to 20% is saturated and unsaturated long-chain fatty acids, squalene and alcohols, and 6% to 9% is cholesterol.

When we are in a heightened state of fear or anxiety we produce more earwax.

There are two different types of earwax, which are determined by a person's genetic type. Asians and Native Americans tend to have the dry, gray, flaky type of cerumen, while Europeans and Africans have the wet, honey-to-dark brown and moist type. Anthropologists examine earwax when tracking human migratory patterns.

Soft and hard earwax - children are more likely to have soft earwax. Earwax problems tend to be caused by the hard type.

According to Medilexicon's medical dictionary, Cerumen is:

"The soft, brownish yellow, waxy secretion (a modified sebum) of the ceruminous glands of the external auditory canal."
What are the signs and symptoms of earwax problems?
Earwax only causes problems when there is an excessive accumulation, leading to a blocked ear, which can affect hearing. A blocked ear may also be painful. When the earwax build-up hardens and blocks the ear canal, it forms a plug (blockage).

People with blocked ears caused by too much earwax may experience:

Earache
Itchiness
Ringing in the ears (tinnitus)
Vertigo - a sensation of slight loss of balance, a feeling that you are moving when you are not.
Cough - this is are and may be caused by nerve-stimulation from the inside of the ear when pressure in the area is increased.

Most hearing-aid faults are believed to be caused by excessive earwax build-up.

Experts urge patients not to try to remove earwax blockages themselves. You should see a doctor.
What are the causes of excessive earwax build up?
Earwax blockage or impaction occurs more frequently in people who produce a lot of earwax. The wax gets pushed deep inside the ear canal.

According to GPs (general practitioners, primary care physicians, family doctors) in the UK, the most common causes of ear blockages among their patients are:

The use of Q-tips (cotton buds) in the ear, as well as other objects people commonly use to attempt to clean their ear or relieve itching, such as keys, rolled napkin corners and bobby pins. Rather than clean the ear out, they tend to push the wax deeper into the ear canal.

Using cotton buds commonly leads to earwax blockage

Hearing aids and earplugs - such objects encourage a build-up of wax within the ear because they prevent the earwax from falling out naturally.

Swimming - some people produce a lot of earwax when/after they go swimming.

Who is more at risk of excessive earwax build up?

Individuals whose ear canals are not fully formed
Patients with very hairy ear canals
People whose ear canals are narrow
Patients with a history of recurring impacted earwax
People with osteomata - benign (non-cancerous) bony growths in the outer part of the ear canal
People with recurring ear infections
Those with certain types of skin conditions
Some people with learning difficulties. Experts do not know why.
Elderly people. As we get older our earwax tends to get drier and harder, which increases the risk of impaction.

Diagnosing excessive earwax build up
The doctor examines the patient's ears using an auriscope, also known as an otoscope. Determining whether there is a build-up of earwax is easy for a medically-trained professional. They will also know whether it is firmly lodged within the ear canal (impacted).

Examination of the ear canal with an otoscope

If there is any hearing loss, this may be tested once the ear has been cleared to rule out any other causes.
What are the treatment options for earwax build up
In the vast majority of normal earwax cases, it falls out on its own and no treatment is required. According to the American Academy of Otolaryngology, removing earwax should only occur if the build-up is causing health problems. However, if it is impacted and the patient has unpleasant symptoms of pain or hearing loss, it may need to be removed.

Eardrops

The doctor will usually prescribe eardrops to soften the wax, making it easier to remove. When eardrops are placed they should be at room temperature. In most cases, within a few days, the wax will soften and gradually come out on its own. If the patient has a perforated eardrum, eardrops should not be used.

Ear irrigation

If the eardrops do not work, the doctor may recommend irrigation, which in lay terms means washing the ear out - a pressurized flow of water is applied to the ear canal to dislodge and remove the plug.

In the past, a metal syringe was used to irrigate the ear; there was a slight risk of damage. Nowadays, doctors use an electronic ear irrigator which has a pressure control, making sure the initial pressure is as low as possible. Water, which is at body temperature, is squirted into the ear canal at a carefully controlled flow. The ear may be held at different angles to make sure the liquid reaches every part of the ear canal.

In cases of severe earwax impaction (cerumen impaction), the doctor may look inside the ear with an auriscope several times during the irrigation process.

Ear irrigation is not painful, but the patient may find the sensation of having water squirted into his/her ear strange.

Depending on the symptoms, the doctor may investigate further to check whether there is an infection.

If the irrigation does not work, the patient may need to use eardrops for a few days to soften the wax further, and then come for another irrigation, or he/she may have water placed in the ear before the procedure is repeated again about 15 minutes later.

A GP who does not manage to get the plug out using irrigation will probably refer the patient to an ENT (ear, nose and throat) specialist.

In the following cases, ear irrigation might not be recommended:
A previous irrigation procedure was linked to problems, such as severe vertigo or pain

Ear surgery was performed on the patient within the previous 12 months

The child has grommets

The ear canal is blocked with some other foreign body

The patient has a cleft palate, or had one (even a patient whose cleft palate was repaired should not undergo irrigation

The patient has a perforated eardrum, or had one within the previous 12 months

The patient has otitis externa

The patient recently had otitis media (middle-ear infection)

There is a mucus discharge from the ear. This could be caused by perforation which has been overlooked

If ear irrigation is still unsuccessful, or not possible, the doctor may recommend either microsuction or aural toilet.
What are the possible complications of earwax build up?
Ear infection - if the impacted earwax is left untreated, there is a risk of infection. Very rarely, the infection may spread to the base of the skull, causing meningitis or cranial paralysis.

Vertigo - if the earwax pushes against the tympanic membrane (eardrum), the patient may feel he/she is moving (when not moving).

Written by Christian Nordqvist

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