Dealing with earwax impaction – A blockbuster

Earwax is a vital substance, necessary for the natural cleaning process of our inner ears. As the saying goes “too much of a good thing is not always a good thing”, an expression very fitting for earwax, which if you lend an ear you’ll see in action through earwax impaction.

Moreover, earwax impaction is a term used to describe a buildup of earwax that becomes wedged in, so much so that it blocks the ear canal. This blockage is commonly the consequence of your body producing more earwax than is required, like wax-on without the wax-off. This isn’t however the only culprit of earwax impaction, which we will point out and discuss in more detail later on.

All about earwax impaction – A comprehensive infographic


What is ear wax

What is earwax

Earwax is a waxy substance secreted by glands in the ear canal (a hollow tube that runs from the eardrum towards your outer ear). Let’s delve a little deeper.

What is ear wax made of?

What is earwax made of

Ear wax is a product of its environment, which in this context means it is built up of substances and materials within the ear. Cerumen is a term commonly used interchangeably with earwax, however, this isn’t entirely the case.

Cerumen is secreted by the ‘ceruminous’ and ‘sebaceous’ glands of the ear canal, and forms the basis of earwax, along with many other substances, including dead skin cells and hair, to more complex materials such as saturated and unsaturated fatty acids, squalene, alcohols and cholesterol. 

How does earwax clean the ear?

So how does earwax clean the ear

In basic terms, the cells that line your ears have the ability to migrate (move), which they do form the middle of the eardrum, towards the entrance of the ear canal (the outer ear). As these cells move, earwax is dragged along with them and towards the outer ear canal. In doing so this earwax takes any hazardous particles along with it. This process “usually” occurs at a rate comparable to the growth of our nails.

The benefits of earwax

The benefits of earwax

Earwax, alongside tiny hairs, has the key role of keeping dust and other foreign (outside) particles from entering the inner ear, that would have otherwise caused damage to deeper, more delicate structures such as the eardrum. 

Another benefit relates to the moistening effect that earwax has on the ear canal, helping to prevent dryness and itchiness, which as you can imagine would be annoying to deal with. 

From the many different constituents that form ear wax, ‘saturated fatty acids’ and ‘cerumen’ have the benefit of adding an acidic property to earwax, helping to create a protective acidic layer. By creating an acidic environment, earwax protects the ear canal from infection, which it achieves by killing and preventing the growth of bacteria and fungi, which would have otherwise had free rein to cause infection. 

Earwax also contains lysozyme, an anti-bacterial enzyme (protein) capable of killing bacteria by destroying their cell walls and ultimately causing them to burst.

Jaw movement and earwax

How can jaw movement help in removing earwax

You might have heard the old wives’ tale that chewing gum helps in the removal of earwax. Ironically enough, this is one time we shouldn’t fall on deaf ears, as it is now scientifically proven that jaw movement when chewing helps in dislodging any particles attached to the sides of the ear canal. Moreover, these loose particles are able to be moved towards the outer ear, ready for expulsion. 

How do ears get blocked?

How does earwax impaction occur (earwax blockage)

As you have now hopefully realised, our ears are very efficient at cleaning themselves. Ironically, it’s usually when people take the initiative to clean their ears that earwax impaction occurs. But, for people to feel the need to remove earwax themselves, there must be a reason, which in more cases than not is owed to a malfunction in the earwax making process.

In most people, earwax makes its way towards the opening of the ear, where it is then washed away or simply falls out. Subsequently, more space is created within the ear, allowing for new earwax to takes its place. This cycle can be disrupted when your body secretes too much earwax, or when the process of removing earwax is disturbed, both of which can lead to an accumulation of earwax, eventually leading to blockage (earwax impaction).

For some people it is as simple as being dealt bad genetics, most commonly whereby the rate of earwax production outweighs the rate of removal. 

Some other examples of triggers and risk factors that make people more prone to earwax impaction include: 

  • Being genetically predisposed to producing hard and/ or dry earwax, which is more difficult to remove, and as a result is more likely to accumulate.
  • As a part of the natural aging process, as with with age earwax naturally becomes drier and harder.
  • Being born with narrow, oddly shaped or hairy ear canals, making you more prone to earwax accumulating and becoming jammed.
  • People with learning difficulties are seemingly more prone to earwax impaction, and the exact scientific reason for this is still unknown.
  • Bony growths in the outer part of the ear canal, such as osteoma (new bone growth on bone) or exostoses (outgrowth of cartilage tissue on bone) can physically prevent the removal of earwax.
  • Excessive production of earwax is not always genetic, and can be triggered by an injury, or certain medical conditions, including: skin condition such as eczema (causes dry wax), or autoimmune conditions such as lupus and sjogrens syndrome.
  • Exposure to moisture (e.g. during swimming or showering) causes earwax to expand and in turn may increase the likelihood of blockage. 
  • The insertion of objects into the ear canal may also be a contributory factor. This can be intentional, by compressing earwax via the inappropriate use of cotton buds, or inadvertently by preventing the removal of earwax by wearing earbuds, earphones or hearing aids.

Symptoms of earwax impaction

Symptoms of earwax impaction

Don’t let the colour and consistency of earwax be a determinant of the severity of impaction (blockage), as appearance varies from person to person, and can range anywhere from light yellow to dark brown based on your environment and diet.

Symptoms of earwax impaction can occur directly as a result of the blockage, or as a result of an infection consequent to latent earwax buildup. 

Signs and symptoms of earwax buildup

Signs and symptoms of earwax impaction

  • A sudden or partial loss of hearing, which in most cases is only temporary.
  • Tinnitus, whereby an individual hears high-pitched tones (e.g. ringing or buzzing) coming from within the ear. Tinnitus occurs as a result of impacted earwax placing pressure and irritation on the eardrum.
  • A feeling of your ears being plugged, or a sensation of fullness.
  • An earache, which is due to the increased pressure placed on delicate structure(s) within the ears, for example, the eardrum.
  • A cough, which may occur when the earwax gets lodged in such a way that it stimulates the vagus nerve, which is connected to the cough centre in the brain.

Signs and symptoms of infection with earwax impaction

  • Discharge running out of the ear.
  • Odour coming from within the ear canal.
  • A high temperature (fever) of 38°C or above.
  • A persistent loss of hearing.
  • Itching in your ear.
  • Dizziness, which isn’t necessarily vertigo, but may still cause you to feel a sense of unsteadiness.

Our inner ear sends signals to the brain, which help us track our body’s movements, and in turn giving us a sense of balance. Dizziness occurs when these signals are disrupted.

The above-listed symptoms have some overlap with symptoms seen in cases of a perforated eardrum.

Please bear in mind that hearing loss, dizziness and earache are not symptoms exclusive to earwax impaction, and can also occur as a result of many other health conditions. For this reason, if these symptoms are persistent, be sure to see your doctor to get a more clear diagnosis of the underlying cause(s). 

Treatment of earwax impaction

How to treat earwax impaction

Important – If you have any pain in your ears, or have noticed any discharge, do not attempt to treat yourself at home, rather you need to see your GP straight away.

About ear drops

The most common method of treating earwax impaction – Ear drops

Generally speaking, ear drops used for the removal of earwax can be split into two types, ‘oil-based’ and ‘water-based’.

The most commonly seen oil-based ear drop preparations are made using olive oil, whereas other examples such as almond oil or peanut oil (arachis oil) do exist. The mechanism by which oil-based ear drops remove earwax is through their lubricating effect, which softens the earwax, making the natural removal of earwax a more easy process. Please keep in mind any nut allergies that you may have when purchasing oil-based ear drops.

Water-based ear drops contain ingredients such as hydrogen peroxide and sodium bicarbonate, which work mechanically to remove earwax. These ear drops are alkaline in nature, whilst earwax is of an acidic PH. 

This allows water-based ear drops to chemically dissolve earwax, rather than the softening effect that oil-based ear drops have.

Researchers are yet to rank one type of ear drop above the other, and for this reason, the treatment of choice is case dependent and is best determined by a pharmacist or another healthcare professional.

How to use ear drops – A simple guide

When using ear drops, it is best to do so with a dropper device, as this will allow for precision in terms of placement and amount.

Once the ear drops enter the ear, it is recommended that you lay on your side for a couple of minutes, with the treated ear facing the ceiling. This gives time for the ear drops to move along the ear canal, to most optimally exert their effect. 

After this time has elapsed you may use a tissue or cotton wool to soak up any excess ear drops leaking from the ear, but be sure not to insert anything into the ear.

The exact number of drops may vary between different preparations and brands, as well as the extent of the blockage. In general, you can expect to administer 2 -3 drops, once or twice daily. However, to be sure, feel free to ask a pharmacist, or read the “patient information leaflet” for specific instructions.

The treatment duration is typically 1 – 2 weeks, during which point you should notice earwax falling from the ear. Earwax is more likely to fall out if you are laying on the treated ear(s), especially the case during sleeping hours whereby you are in said position for long periods of time.

Irrigation for earwax removal

Most of the time ear drops are enough to get the job done, however occasionally require additional assistance following treatment with ear drops. One of the most common methods of removing earwax in a healthcare setting is by ear irrigation, or as it is more commonly known, “ear syringing”. This process may also be carried out at home by using a ‘do-it-yourself’ ear syringing kit. 

The process of syringing ‘irrigating’ your ear(s) – A step-by-step guide

Note that this procedure cannot and should not be carried out if you currently have or have had a recent infection or a perforation of your eardrum. 

Ear syringing or irrigation is the process of dislodging impacted earwax by the application of light pressure using water flushing. Ear syringing can be performed at home, and below is a step by step guide on how you can do so:

  1. Using a soft rubber bulb made for ear irrigation (which can be purchased online or from a pharmacy), which you fill with warm, preferably body temperature water. Warm water is the recommended temperature, as irrigation with hot or cold water may provoke an uncomfortable reaction, for example, dizziness or nauseousness. 
  2. Tilt your head to the side while placing a towel or a large bowl below the ear you are irrigating. This is so that you can avoid making a mess with the water, whilst also collecting any wax which may fall out. 
  3. Now that you are positioned correctly, point the water-filled rubber bulb toward the affected ear and squeeze until the warm water shoots into your ear. Preferably, this should be done by somebody else, as they will likely have better accuracy.
  4. Once the water is squeezed into the ear, it will naturally run back out. Allow the water to run down into the towel or bowl. 
  5. Irrigation does not necessitate any prior use of ear drops to effective, but it is recommended for better results. This is especially the case where there is hardened earwax.

Earache with earwax impaction

Treatment for earache caused by earwax impaction

There are some things which you’re able to do at home to help relieve earache and ear pain, which include:

  • The use of painkillers, such as paracetamol, ibuprofen and in some instances aspirin is usually adequate enough to relieve ear pain caused by earwax impaction. However, it is important to bear in mind that children under the age of 16 years should not take aspirin, as there is a risk of developing the serious and potentially fatal condition known as ‘Reye’s syndrome’.
  • You may also benefit from placing a warm (not hot) or cold flannel on the ear, as it helps to relieve the pain.

When home treatments fail, it may be time to see your doctor

If the use of ear drops and home irrigation proves ineffective, we recommend that you seek medical assistance. After having ruled out any other causes for your symptoms, and confirming earwax impaction, your doctor may use a variety of methods for removing earwax:

  • They may again attempt irrigation, however using a more advanced electronic irrigator, which works in the same way as explained above.
  • They may also try to remove earwax by the micro-suction method using a suction device. This suction device works in a similar way to a vacuum cleaner and is likewise quite noisy. You may be advised to soften the earwax before the procedure with ear drops if your earwax is found to be too hard. 
  • Lastly, your doctor may have to get stuck in with a curette, which is a small, curved instrument designed to be inserted into the ear for direct removal of ear wax. This procedure is surprisingly safe when conducted by a healthcare professional.  

What not to do when attempting to remove earwax at home

Never insert cotton swabs into your ears, and likewise any other small object. This practice not only further compresses earwax, making earwax impaction worse, but may also directly damage delicate structures in the ear. 

About ear candling

What is ear candling

Ear candling is a seemingly medieval technique for earwax removal, which despite the risks it poses, is becoming increasingly popular.

What does the process of ear candling involve

The process of earwax candling involves the use of a hollow tube (typically made of cotton) which is encased in candle wax. These candles typically come equipped with a shield, with aim of preventing hot melted wax from falling on and burning the face. The procedure begins by placing the hollow candle tube into the ear, at which time it is lit. The heat produced by the flame is said to create a vacuum effect, which sucks wax from the ear canal, and deposits it in the candle. It is also thought that the heat from the candle may cause the earwax to melt, making its removal easier.

Is ear candling recommended for removing earwax

In short, NO. Ear candling at its best falls short of other methods of earwax removal, and at its worse is a very risky and dangerous procedure, considering you have a lit candle close to your face.

In theory, the wax may also drip into your ear canal, which can further exacerbate symptoms of earwax impaction, and also potentially damage the more delicate structures in the ear such as the eardrum.

What are the potential dangers of ear candling

Potential dangers of ear candling-1
When to see a doctor for earwax impaction

When to see a doctor for earwax impaction

For alot of us, going to the doctors surgery is a last resort for when things fail to improve with home remedies. However, having an understanding of when it is appropriate to see a doctor is essential considering how scarce appointments have become in the age of Coronavirus (Covid-19).

So when should you see your doctor for earwax impaction?:

  • Ineffective treatment with home remedies, including the use of ear drops which have been used for 5 days to no avail, or ear irrigation ‘syringing’ has proven ineffective following a couple of attempts.
  • Signs and symptoms indicative of an ear infection (refer to the signs and symptoms section for more details).
  • Intense and/or unremitting pain, which may point to a perforated eardrum, in which case home treatment should be avoided.
  • Sudden and complete hearing loss with no sign of it ceasing.
  • A suspected foreign body in the ear, common amongst children. A sign of this may be the presence of blood.

Hearing loss and vertigo may the consequence of excess earwax build up. The lack of balance and equilibrium brought on by vertigo can prove dangerous, especially for the elderly, who are at greater risk of complications from falls.

As we’ve mentioned previously, some of the more serious symptoms seen in earwax impaction are also shared with other medical conditions. Because of this, it is vital to see your doctor if any of the more serious symptoms become frequent, as a full medical evaluation can help determine whether the problem is due to excess earwax, or another medical condition altogether.

earwax impaction red flags

Conclusion

Earwax impaction is very common, and we hope that our advice and recommendations are music to your ears. We hope that you have a better understanding on the best way to treat earwax impaction, rather than ‘playing it by ear’.

Please share with your friends and family, and above all Behealthible.

References

https://www.cedars-sinai.org/health-library/diseases-and-conditions/i/impacted-earwax.html

https://www.dizziness-and-balance.com/disorders/hearing/wax2.html

https://www.health.harvard.edu/staying-healthy/got-an-ear-full-heres-some-advice-for-ear-wax-removal#:~:text=An%20ear%20canal%20plugged%20up,in%20some%20loss%20of%20hearing

https://www.healthline.com/health/ear-irrigation

https://www.healthline.com/health/ear-wax-removal-home-remedy

https://www.mayoclinic.org/diseases-conditions/earwax-blockage/symptoms-causes/syc-20353004

https://www.medicalnewstoday.com/articles/248934

https://www.nhs.uk/conditions/earache/

https://www.nhs.uk/conditions/earwax-build-up/

https://www.nhs.uk/conditions/perforated-eardrum/#symptoms

https://www.specsavers.co.uk/hearing/earwax/impacted-earwax