What helps if earwax builds up?
Various ear drops can soften earwax in the outer ear canal and make it easier to remove. But home remedies like warm olive oil can also work just as well.
Earwax plays an important role in how the outer ear canal cleans itself. This canal connects the outside visible part of our ear with the eardrum. Although dirt can get into the outer ear canal, most of the "dirt" found in the ear is actually made up of tiny dead skin particles. These dead skin particles are normal because the skin keeps renewing itself through constant shedding.
In order to clean the outer ear canal, glands known as the ceruminous glands secrete fats and other substances. These secretions keep the skin of the ear canal soft, and give it a protective acidic layer. This acidic environment protects the ear canal from infection by killing bacteria and fungi. Earwax is made up of the secretions, shed skin flakes and dust particles. The medical term for earwax is cerumen. This oily mass is constantly pushed towards the outer ear by the natural movements of our lower jaw – for instance, when we speak and eat – and this helps to keep our ears clean.
What causes plugs of earwax to build up?
The amount of earwax that is produced varies from person to person and has nothing to do with personal hygiene. The buildup of earwax in the outer ear canal is particularly common in men and older people. Our earwax also changes in older age: The ceruminous glands start to shrink and make less secretions. The earwax becomes drier, but dead skin particles still continue to build up. The outer ear canal can then no longer clean itself as well as it does in younger people.
If a lot of earwax is made, or if dead skin particles build up in the ear canal, a plug of earwax may form and affect your hearing. Experts estimate that removing an earwax plug can improve hearing by 10 decibels. To give you an idea of what this means: The difference between quiet whispering and normal conversation is about 20 decibels.
Older age isn't the only thing that can affect the ear’s ability to clean itself. Cleaning your ears with cotton buds or similar objects may cause problems too. Doing so only removes some of the earwax – the rest is usually pushed further into the ear, where it may become harder and form a plug. There is also a risk of irritating or injuring the eardrum or the skin lining the outer ear canal.
Hearing aids, in-ear headphones or earplugs worn to protect you from noise, dust or water may also cause earwax to build up and harden if used too often.
How can you remove earwax?
You can normally use a soft washcloth or facial tissue to remove earwax that has come out of the ear, for instance after washing or having a shower. There are different ways to remove larger amounts of earwax from the outer ear canal, or to remove hard plugs of earwax:
- Softening the earwax at home: Warm olive oil, almond oil, water or special ear drops and sprays (called cerumenolytics) can be used to soften the earwax, allowing it to leave the ear more easily.
- Having your ear rinsed (irrigation) or cleaned at the doctor's: Your family doctor or ENT (ear, nose and throat) doctor can rinse out the outer ear canal or remove the earwax using special instruments.
Before having your ear rinsed by the doctor, you can try out cerumenolytics at home first. If they don't get rid of the earwax, they can still help to prepare the ear to be rinsed out by a doctor (irrigation).
Irrigation isn't always suitable – particularly in people who have a damaged eardrum or a middle ear infection. An ENT doctor can then decide how a hardened plug of earwax should best be removed.
Which approach is most effective?
To find the most effective way to remove earwax, researchers from the University of Southampton in Great Britain analyzed a total of 22 randomized controlled trials (good-quality studies) testing different approaches.
Overall, these studies show that cerumenolytics and oils can effectively remove earwax, and that ear irrigation works better when cerumenolytics are used first.
But these results aren't completely reliable: Most of the studies only looked at a small number of people, and some had other weaknesses as well.
Researchers from the Cochrane Collaboration – an international research network – also looked at studies on different types of ear drops for removing earwax. Their results aren't reliable either, but they point in the same direction: Ear drops can help. It's not clear whether certain products are more effective than others, though.
As well as using cerumenolytics, some people use complementary or alternative treatments such as "ear candles." These candles are placed in the ear canal and then lit on the other end. It is claimed that the candles help to soften and remove earwax, but this hasn't been proven in scientific studies.
What's more, the U.S. regulatory authority FDA has issued a public warning that the use of ear candles can lead to serious ear injuries.
What are the possible side effects of the various approaches?
Most of the studies looking at the side effects of ear drops found that they either had no side effects, or that side effects were rare. These side effects mainly included itching, dizziness, skin irritations, and inflammation of the outer ear canal.
The outer ear canal can also become inflamed after earwax has been removed with cotton buds or sharp objects. Removing earwax also removes the natural protective barrier in the ear canal.
Ear irrigation rarely leads to side effects, as long as it is done by a doctor.
Aaron K, Cooper TE, Warner L, Burton MJ. Ear drops for the removal of ear wax. Cochrane Database Syst Rev 2018; (7): CD012171.
Clegg AJ, Loveman E, Gospodarevskaya E, Harris P, Bird A, Bryant J et al. The safety and effectiveness of different methods of earwax removal: a systematic review and economic evaluation. Health Technol Assess 2010; 14(28): 1-192.
US Food and Drug Administration (FDA). Don't get burned: Stay away from ear candles. 18.02.2010.
Wright T. Ear wax. BMJ Clin Evid 2015: pii: 0504.
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