Cerumen Impaction

Earwax

What is commonly known as ear wax is a mixture of cerumen and skin. Cerumen glands are at the bottom hair follicles, which are only found in the outer third of the ear canal. Cerumen formed in these glands is essential for the normal health of the ear. This cerumen melts and forms a coating all over the skin of the ear canal, even deep inside over the drumhead. This protects the ear canal skin from getting wet and boggy, just the way the wax of a paper cup protects the paper becoming saturated. Because of this, water that enters the ear canal will bead up rather than soak into the skin and can roll back out of the ear canal. If the wax gets washed out of the ear because of frequent swimming, showering, or excessive use of wax-removing drops, the skin of the ear may become moist bacteria that are always present in the ear canal may flourish, causing an infection. This is what a painful swimmer’s ear is. Swimmer’s ear is also commonly known as otitis externa. Cerumen also helps to prevent infection in the ear by inhibiting the growth of both bacteria and fungus with its slightly acidic pH. The wax in the ear canal may be dry or wet, yellow, brown, or black. The wax that builds up in the ear canal is usually a mixture of the skin migrating out of the canal and the cerumen forming in the cerumen glands of the outer part of the canal. Normally, this wax will come out of the ear canal on its own, but as we age, the ear wax tends to become more dry and stiff and may tend to pile up in the ear canal rather than flow out of it on the converyor belt of migrating skin. It should only be removed if it is becoming bothersome from a comfort standpoint, is blocking sound getting into the ear, or is preventing inspection of an ear. Often, softening the wax is all that is necessary to allow the ear to clean itself naturally. There are many products on the market to soften wax and they work in different ways. Some work by wetting the skin flakes imbedded in the ear wax which causes them to swell and to break the plug of hardened ear wax apart. Simple water will do this quite well but will leave the ear canal wet and prone to infection. Wetting the skin with peroxide both breaks up the wax plug and sterilizes the canal so that a secondary infection is avoided. Simple oil, such as baby oil or mineral oil, can often be used successfully to soften the cerumen portion of the plug, and if used just a few times a year, can prevent repeated visits to the doctor’s office to have occluding ear wax removed. Filling the ear canals with baby oil on the 1st day of every season can soften wax enough to prevent problems in many individuals. Oil or peroxide-based drops should only be used if the eardrum is intact. Oil or peroxide that passes through a hole in the eardrum (or tympanostomy tube) will cause pain and may cause infection. In many cases, attempts to use cotton-tipped swabs to clean the ear has the unintended effect of pushing the wax deep into the ear canal against the eardrum. When this occurs, it may be difficult to clean wax from the canal using conventional methods such as a wax curette or flushing the ear canal and the wax must be carefully removed by an experienced ear physician using a microscope designed for ear work.