All About Earwax

It is not just that stuff, it is a lot more!

Content

What us earwax
Why do I produce more earwax
What your earwax colour means
What your earwax smell means
Benefits of earwax
Symptoms of compacted earwax
Hearing aids and earwax
Micro suction & Irrigation - Pros and Cons

A picture of an ear in black and with a yellow background

What is Earwax

Ear wax is a normal, healthy substance that helps to protect our ears from infection. It usually breaks down naturally and falls out of the ears in tiny flakes. If you wear a hearing aid, or have a narrow or curving ear canal, the wax may build up in your ear, causing discomfort, a sensation of fullness or some loss of hearing and you may not get the best results from your hearing aid. Cerumen is produced in the outer third of the cartilaginous portion of the ear canal. It is a mixture of viscous secretions from and less-viscous ones from modified apocrine sweat glands. The primary components of earwax are shed layers of skin, with, on average, 60% of the earwax consisting of keratin, 12–20% saturated and unsaturated long-chain fatty acids, alcohols, squalene, and 6–9% cholesterol.

There are two distinct genetically determined types of earwax, there is the Wet, which is the more dominant type (honey-brown to dark-brown and moist) and is more common among Caucasians and Africans. As many as 97% of Africans/Europeans have this type of ear wax, which is used for self-cleaning, preventing dryness, and helps to promote sweat production. The other which is Dry, is the recessive type, and is more common among Native Americans, Pacific Islanders, and Asians. Up to 95% of East Asians/Native Americans have dry ear wax, and it’s

believed to have resulted from living in colder climates reducing sweat body odour. There are, of course, the sub-types of wax which are tarry, classic wet, and firm nuggets and dry flakes and “cornflakes"

The amount of ear wax that the body produces differs from person to person, the amount that is retained within the ear also differs for each of us - these differences are for a number of reasons:

Age
Diet
Lifestyle
Personal anatomy
Genetics
Ethnicity

Many people will produce a small amount of wax their whole lives, which leaves the ear canal naturally, and never have any problem with it. For others, their ear will produce a larger amount of wax, which will not fully leave the ear canal and will become blocked, which leads to them having reduced hearing ability and also a blocked feeling in the ear.

Why Do I Produce
More Earwax

As briefly mentioned above the amount and type of earwax produced can vary greatly among individuals due to several factors, and it's not uncommon for one ear to produce more wax than the other. Here are some reasons why these variations occur:

Genetic Factors

Ethnicity and Genetic Makeup: Studies have shown that genetics play a significant role in determining the type and amount of earwax an individual produces. For example, people of East Asian descent tend to produce dry earwax, while those of African or European ancestry typically produce wet earwax. The quantity of earwax can also be influenced by genetic factors.

Environmental Factors

Climate and Environment: Individuals living in warmer climates may produce more earwax due to increased perspiration in the ear canal, which stimulates wax production. Conversely, colder climates can lead to harder, less frequent earwax.

Health and Lifestyle Factors

Age: The production of earwax tends to decrease with age, which is why older adults may have drier and less earwax.
Diet: Although less studied, some believe that diet can influence earwax production, with certain vitamins and minerals potentially playing a role.
Over production of cerumen can be triggered by the deficiency of Omega-3 fatty acids, zinc and magnesium.
Use of Earphones/Earplugs: Regular use of earphones, hearing aids, or earplugs can stimulate earwax production by irritating the ear canal.

Anatomical Factors

Differences in Ear Canal Anatomy: Individual variations in the shape and size of the ear canal can influence earwax accumulation. For instance, a narrower or hairier ear canal might trap wax more readily, leading to increased buildup.
Side Dominance: Some theories suggest that the side of your dominant hand could lead to more earwax production in that corresponding ear due to more frequent manipulation or touching of the ear, although evidence for this is anecdotal.

Why It Happens More in One Ear Than the Other

The reason one ear might produce more wax than the other could be due to a combination of the factors above, especially anatomical differences or habits related to ear manipulation. It's also possible that blockages or partial blockages in one ear can give the appearance of producing more wax, when in reality, it's just accumulating more due to reduced natural clearance.

In most cases, variations in earwax production are normal and not for concern. However, if excessive earwax is accompanied by symptoms like hearing loss, pain, or discharge, it's advisable to consult a healthcare professional for evaluation and management.

Hygiene and Cleaning Practices

Over-Cleaning: Ironically, using cotton swabs or other objects to clean the ears can actually stimulate more wax production. The ear perceives this as an irritation or injury, leading to increased production of earwax as a protective measure. This could also lead to impaction if wax is pushed deeper into the ear canal.
Soap and Water: Frequent washing of the ear can strip away the natural oils, leading the ear to produce more wax in an attempt to compensate for the lost lubrication.

Medical Conditions

Eczema or Skin Conditions: Individuals with skin conditions like eczema or psoriasis in or around the ear canal may produce more wax. These conditions can cause the skin to flake, and these flakes can mix with earwax, increasing the overall volume.
Infections: Ear infections can stimulate the glands in the ear canal to produce more wax as a defensive mechanism against bacteria or fungi.
Otitis Externa: Also known as swimmer's ear, this condition can cause inflammation of the ear canal, leading to increased earwax production as part of the body's response to infection.

Medications and Supplements

Some medications, particularly those that affect the skin and mucous membranes, could theoretically alter earwax production, though specific studies on this are limited. Hormonal changes or imbalances might also play a role, affecting the body's secretions in various ways, including in the ear canal.

Stress and Anxiety

There is some evidence to suggest that stress and anxiety can increase the production of earwax. The theory is that stress affects hormonal balances and can lead to increased body secretions, including in the ear.

Individual Variation

Finally, it's important to note that there's a significant amount of individual variation when it comes to earwax production. Some people naturally produce more earwax than others without any clear external cause. This variation is normal and, in most cases, doesn't indicate any underlying health issue.

What Your Earwax Colour Means

Earwax (cerumen) issues, understanding the significance of different types of earwax and their colour variations can offer valuable insights into ear health and hygiene practices. Earwax is not merely a byproduct of the body's processes but serves important protective, lubricating, and antibacterial functions for the ear canal. The consistency and colour of earwax can vary due to genetics, age, diet, environment, and overall health, and these variations can sometimes indicate health issues or hygiene practices that need adjustment.

Colour Variations and Their Significance

Light Yellow to Dark Brown: Normal earwax varies from light yellow to dark brown. Darker colors are typically older earwax; the color darkens as the wax traps more dirt and debris over time.
Grey Earwax: While often normal, particularly for those with dry earwax, gray earwax can sometimes indicate dust accumulation. If it appears flaky and is not accompanied by other symptoms, it's usually not a concern.
Black or Dark Earwax: Black or very dark earwax may alarm some people; however, it often just indicates older earwax. If it occurs suddenly or is accompanied by pain, itching, or discharge, it's advisable to consult a healthcare professional, as these could be signs of a blockage or infection.
White Earwax: Lighter, whiter earwax with a flaky consistency is typical of the dry earwax genotype. It's also normal but can sometimes indicate a lack of certain substances in the earwax that help fight
Red or Bloody Earwax: If earwax appears red or has blood, it might be due to a scratch in the ear canal, often from trying to clean the ears with sharp objects like cotton swabs. If bleeding is persistent, it's important to seek medical advice, as it could indicate a more serious issue.

Health and Hygiene Implications

Indicators of Hygiene Practices: Excessive or impacted earwax can

indicate overuse of earbuds, poor cleaning habits, or the overuse

of cotton swabs, which can push wax deeper into the ear canal.

Health Indicators: Changes in earwax consistency, color, or production rate can signal health issues. For example, a sudden change in the smell or color of earwax, especially if accompanied by discharge, could indicate an infection.

Recommendations for Patients

Safe Cleaning Practices: Advise against inserting objects into the ear canal, including cotton swabs. Recommend safe cleaning practices, such as wiping the outer ear with a damp cloth.
Seek Professional Help for Impaction: If there are signs of earwax impaction, such as hearing loss, earache, or a sensation of fullness in the ear, recommend consulting an audiologist or physician for safe removal.
Regular Check-ups: Encourage regular ear check-ups, especially for patients prone to excessive earwax production or impaction, to maintain optimal ear health.

A round chart showing different colour earwax and its meanings

What Your Earwax
Smell Means

The colour and consistency of your pee, poop, saliva, and snot can signal potential health issues—or reassure you that all’s well. And the same is true of the stuff that oozes out of your ears.

Odourless to Mild: Healthy earwax typically has a slight, musty smell that is not strong or noticeable unless you’re specifically trying to smell it. In many cases, earwax doesn’t have a strong odour.
Sweet or Musty: A slightly sweet or musty odour is normal and can be a result of the cerumen's composition and its role in trapping dirt and debris.
Strong and Foul: A strong, foul odour emanating from the earwax can indicate an infection or disease. Conditions like otitis externa (external ear infection) or otitis media (middle ear infection) can cause the earwax to smell bad due to bacteria or fungi

The colour and consistency of your pee, poop, saliva, and snot can signal potential health issues—or reassure you that all’s well. And the same is true of the stuff that oozes out of your ears.

Odourless to Mild: Healthy earwax typically has a slight, musty smell that is not strong or noticeable unless you’re specifically trying to smell it. In many cases, earwax doesn’t have a strong odour.
Sweet or Musty: A slightly sweet or musty odour is normal and can be a result of the cerumen's composition and its role in trapping dirt and debris.
Strong and Foul: A strong, foul odour emanating from the earwax can indicate an infection or disease. Conditions like otitis externa (external ear infection) or otitis media (middle ear infection) can cause the earwax to smell bad due to bacteria or fungi

Fishy or Sour: A fishy or sour smell can also be indicative of an infection or an imbalance in the microbial flora of the ear canal. It may also suggest a buildup of earwax that has trapped bacteria and fungi, leading to an overgrowth.
Rancid or Putrid: Earwax with a rancid or putrid smell could signal a severe infection or a chronic condition. This type of odor requires medical attention as it could lead to more serious complications.

It's important to note that while certain smells can hint at underlying health issues, they are not definitive diagnoses. If you notice a sudden change in the smell of your earwax, especially if it's accompanied by other symptoms like pain, discharge, hearing loss, or dizziness, it's advisable to seek medical advice. Ear health is crucial, and unusual changes in your earwax’s smell, colour, or consistency should be evaluated by a healthcare professional to rule out infections or other conditions. An example of this is Maple Syrup Urine Disease (MSUD) which gives a sweet smell to the pee, sweat and earwax, and another one is Alkaptonuria, this turns your wax black and urine dark brown

Benefits Of Earwax

Cleaning of the ear canal occurs as a result of the "conveyor belt" process of epithelial migration, aided by jaw movement. Cells formed in the centre of the Tympanic Membrane migrate outwards from the Umbo (at a rate comparable to that of fingernail growth) to the walls of the ear canal, and move towards the entrance of the ear canal. The cerumen in the canal is also carried outwards, taking with it any particulate matter that may have gathered in the canal. Jaw movement assists this process by dislodging debris attached to the walls of the ear canal, increasing the likelihood of its expulsion.
The lubrication provided by cerumen prevents desiccations of the skin within the ear canal. The lubricating properties arise from the high Lipid content of the Sebum produced by the sebaceous glands. In wet-type cerumen at least, these lipids include Cholesterol, Squalene, and many long-chain fatty acids and alcohols

It prevents bacteria, germs, and dirt from getting into your sensitive inner ear. The waxy substance that is your ear wax and

essentially suffocates the bacteria and germs that breed in your

ear canals. Ear wax prevents them from spreading

out of control, preventing infections in your ear.

It collects dirt and slows bacteria growth. The sticky ear wax traps the dirt that blows into your open ear canal. That way, the sensitive skin of your ear canal is safe from irritation and possible infection.
It prevents bugs and insects from creeping in. Imagine if tiny creepy crawlies could get into your ear and lay their eggs. Ew! Thanks to ear wax, which repels insects due to the acidic taste (pH level) (or traps the ones that try to get into your ear), your ears stay bug and insect-free!
If you don’t have enough ear wax, your ears may become itchy. This is because the wax is almost like a moisturizer for your ears. It helps to keep your skin from becoming too dry, which leads to itchy, flaking skin. Ear wax is both a protector and a lubricant.

Symptoms of Compacted Earwax

Frequent ear infections (caused by too much bacteria or germs in the ear canal
Tinnitus, or ringing in yours ears
Otalgia/Pain (from impacted wax)
Reduced movement of the eardrum, causing reduced hearing
Coughing (caused when the pressure inside your inner ear stimulates the nerve )
Whistling of hearing aids:sounds being amplified by the hearing aids are reflected back out of the ear due to the wax causing acoustic feedback

Occlusion: Internal sounds such as chewing, breathing, heartbeat and your own voice can no longer escape out of the ear and are therefore heard much louder
Itchiness/Irritation: wax that is impacted, especially dry wax, will rub against the side of th ear canal upon any jaw movement
Dizziness or vertigo: an increase in the air pressure due to the wax inside the ear canal can inadvertently stimulate the organ of balance
Conductive hearing loss: wax restricts sound waves from travelling efficiently through the ear canal and vibrating against the eardrum

Hearing Aids & Earwax

Hearing aids can contribute to the buildup of earwax in several ways, mainly due to their physical presence in the ear and their impact on the ear's natural processes. Understanding these mechanisms and adopting preventive measures can help hearing aid users maintain both effective hearing aid function and good ear health, minimising the negative effects of earwax buildup. Here's an overview of how hearing aids can cause or exacerbate earwax buildup:

Obstruction of Natural Earwax Migration

Interference with Natural Migration: Earwax (cerumen) is naturally produced in the outer part of the ear canal and gradually moves out of the ear as part of a self-cleaning mechanism, aided by jaw movements such as talking or chewing. The insertion of hearing aids into the ear canal can obstruct this natural migration of earwax, causing it to accumulate.
Compression of Earwax: Regular and prolonged use of hearing aids can push earwax deeper into the ear canal, leading to compaction against the eardrum. This is especially likely if the hearing aid is inserted without care or if it fits too snugly in the ear canal.

Increased Earwax Production

Stimulation of Cerumen Production: The presence of a foreign object in the ear, such as a hearing aid, can stimulate the glands in the ear canal to produce more cerumen (earwax) as a protective response against irritation or infection.
Alteration of the Ear Canal Environment: Hearing aids can affect the environment within the ear canal, potentially altering temperature and humidity levels. These changes can influence the

consistency and of earwax produced, sometimes making it more likely to accumulate or become hard and difficult to remove naturally.

Reduced Ear Canal Ventilation

Reduced Airflow: Hearing aids can reduce airflow in the ear canal, creating a moist, warm environment that may promote the buildup of earwax. Additionally, this environment can encourage bacterial growth, leading to further complications.
Moisture Retention: Hearing aids can also trap moisture in the ear canal, whether from external sources (like swimming or showering) or from perspiration. This moisture can mix with earwax, making it stickier and more likely to accumulate.

Management Strategies

To mitigate the impact of hearing aids on earwax buildup, it's important for users to adopt effective management strategies:

Regular Cleaning and Maintenance: Keeping both the hearing aids and ears clean can help reduce the risk of earwax buildup. Hearing aids should be cleaned according to the manufacturer's instructions, and ears should be checked and cleaned regularly by a professional if necessary.
Proper Fitting: Ensuring that hearing aids are correctly fitted by a professional can minimize their impact on earwax migration and production. Custom-fitted devices are less likely to cause blockage or stimulate excessive cerumen production.
Regular Audiology Check-ups: Regular visits to an audiologist can help monitor ear health, identify issues with earwax buildup early, and provide appropriate interventions to manage it.

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Hearing aids are invaluable for individuals with hearing loss, significantly improving their quality of life by amplifying sound and enhancing communication abilities. However, the presence of compacted earwax can impact both the effectiveness of the hearing aid and the health of the ear canal in several ways. Understanding these effects is crucial to managing and prevent potential issues.

Effects on Hearing Aid Performance

Sound Quality Degradation: Compacted earwax can block the sound outlet or the microphone port of a hearing aid, leading to reduced sound quality. Users may notice that sounds become muffled or less clear, reducing the effectiveness of their hearing aid.
Feedback Noise: Earwax buildup can cause the hearing aid to not fit properly in the ear canal, leading to feedback, which is a whistling sound produced by the hearing aid. This feedback occurs when sound that was supposed to enter the ear canal leaks out and is picked up again by the hearing aid microphone.
Damage to the Hearing Aid: Over time, earwax can damage the hearing aid components, especially if wax makes its way into the device. This can lead to malfunctions and may require repairs or replacement, leading to additional costs

Effects on Ear Health

Ear Canal Blockage: Regular and prolonged use of hearing aids can push earwax deeper into the ear canal, leading to compaction. This blockage can exacerbate hearing loss by preventing sound from reaching the eardrum effectively.
Increased Risk of Infection: Compacted earwax creates an environment conducive to bacterial and fungal growth, potentially leading to ear infections. Symptoms of an infection include pain, discharge, and further hearing loss.
Irritation and Discomfort: The presence of a foreign object such as a hearing aid, combined with compacted earwax, can irritate the delicate skin of the ear canal. This may lead to itching, discomfort, or even pain

To mitigate these issues, it's essential for hearing aid users to maintain a good ear hygiene and have their ears checked regularly, regular cleaning of hearing aids an professional checks. By understanding the interplay between hearing aids and earwax, users can take proactive steps to ensure their hearing aids function optimally while also maintaining ear health.

Micro suction & Irrigation

Earwax Microsuction

This is a cutting-edge and highly precise procedure designed to remove excess earwax and debris from the ear canal. Utilizing a microscope to achieve a detailed view of the ear canal and a medical suction device, this method allows for a clear and direct removal of earwax without the need for water irrigation. Earwax, a natural substance produced to protect the ears from dust, particles, and bacteria, can occasionally build up, leading to discomfort, hearing loss, and infection. Microsuction offers a targeted approach to address this issue, ensuring the ear is kept clean and healthy while minimising discomfort

Pros of Earwax Microsuction:

Precision and Safety: The use of a microscope or Loupes allows for unparalleled precision, reducing the risk of injury to the ear canal or eardrum.
Dry Procedure: Since no fluids are used, there's no risk of infection or complications associated with water retention in the ear, making it ideal for patients with a history of ear infections or perforated eardrum.
Immediate Results: Patients typically experience instant relief and a noticeable improvement in hearing immediately after the procedure.
Comfort: The procedure is generally comfortable, with minimal discomfort reported by most patients.
Suitable for Almost Everyone: Micro suction is safe for nearly all individuals, including those with ear infections, perforated eardrums, or previous ear surgeries.
Time: There is no need for weeks for the drops to soften the wax

Cons of Earwax Micro suction:

Availability: Being a specialised procedure, it may not be as readily available as traditional earwax removal methods and might require a visit to a specialist.
Cost: Micro suction can be more expensive than other forms of earwax removal due to the equipment and expertise required.
Noise: The suction device produces noise that some patients may find uncomfortable, though the sensation is usually brief.
Potential for Discomfort: While generally gentle, some individuals may experience temporary discomfort or dizziness immediately following the procedure.

Earwax microsuction stands out as a modern, effective, and safe option for individuals experiencing problems related to earwax buildup. Its precision and the dry nature of the procedure offer significant advantages over traditional methods, ensuring both comfort and health for the patient's ear. Offering earwax microsuction not only highlights our commitment to providing advanced ear care but also to supply a highly sought-after service.

Earwax irrigation

This is a therapeutic procedure aimed at removing excess earwax, medically known as cerumen, from the ear canal. This process involves gently flushing the ear canal with warm water or a saline solution, helping to dislodge and wash away the buildup of earwax. Earwax, while natural and beneficial for protecting the ear from dust, debris, and bacteria, can sometimes accumulate excessively, leading to discomfort, hearing loss, tinnitus, and infection. Earwax irrigation offers a solution to this common problem, promoting ear health and preventing potential complications associated with earwax buildup.

Pros of Earwax Irrigation

Effectiveness: Earwax irrigation is highly effective in removing excess earwax, especially when earwax buildup causes significant discomfort or hearing impairment.
Non-Invasive: The procedure is non-invasive and gentle, making it a suitable option for many individuals seeking relief from earwax buildup.
Quick Relief: Patients often experience immediate improvement in hearing and relief from discomfort following the procedure.
Professional Supervision: When performed by a healthcare professional, earwax irrigation is safe, with risks and potential complications minimised.

Cons of Earwax Irrigation

Potential for Ear Damage: If not done correctly, there's a risk of ear canal or eardrum damage. This underscores the importance of having the procedure performed by an experienced healthcare provider.
Water Retention: There's a small risk that water may become trapped in the ear canal following irrigation, potentially leading to irritation or infection.
Not Suitable for Everyone: Individuals with certain ear conditions, such as a perforated eardrum, ear infections, or a history of ear surgeries, may not be suitable candidates for earwax irrigation.
Temporary Discomfort: Some patients may experience dizziness or discomfort during or immediately after the procedure.
Tinnitus: Due to not be able to control the accuracy of the water pressure hitting the eardrum with too much force, this can cause the ear muscles to spasm and possibly damage the eardrum. This can cause tinnitus. This normally only lasts for a few days, but it can last months or may be permanent.

Earwax irrigation is a valuable and effective method for managing excessive earwax buildup, offering relief and improved hearing to those affected. However, it's essential for the procedure to be performed under the guidance and expertise of a healthcare professional to ensure safety and efficacy. As an audiologist, providing this service with care and precision can significantly benefit your patients, enhancing their quality of life through improved ear health

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