Earwax - Buildup, Problems, and Removal

Earwax which is also known as cerumen, contains sebaceous material and the products of the ceruminous glands which line the outer one-third of the ear canal. These secretions combine with desquamated skin and hair to form wax.

The wax varies in color and consistency, and its production appears to be partly controlled by circulating catecholamines. It is normal to have some cerumen in the ear canal. Wax provides protection to the skin and also possesses bactericidal activity.

Ear canal epithelium migrates outwards, providing a natural cleaning mechanism for desquamated tissue and cerumen. Attempts to clean the ear by an affected person would invariably force the ear canal contents deeper into the meatus.

Wax impaction (or earwax blockage) therefore is a common cause of hearing loss. If water enters the ear, the desquamated keratin expands, often trapping fluid in the deep meatus. Further, this may lead to an otitis externa unless the plug is removed.

It can be secreted in one of the two forms. Wet wax is produced by most people of African origin and is familiar as moist, sticky, and honey-colored. The dry type is more common in Mongoloid ethnic groups and tends to be more gray in color, less sticky, granular, and brittle.

The gene for wet wax is dominant. Regardless of the type, it is normally loosened by the transmission of movement from the temporomandibular joint by chewing or talking, allowing its passage out of the external auditory meatus. This natural process can be affected by a number of factors and cause impaction.

Earwax is formed on the concave side of the base of the auricle and in the external ear canal. It is a mixture of the secretions of the sebaceous and ceruminous glands.

The secretion of the sebaceous glands being gray to white and that of the ceruminous glands being brown, the color varies with the relative contribution of each. A thin layer is normally present in the areas where the glands are located and sometimes small lumps are found at the base of the auricle at the entrance to the ear canal.

The odor is usually described as aromatic, but if the skin of the base of the auricle and the ear canal is inflamed, the production can be increased and its composition can be changed. An increase and alteration in the bacterial flora can change the appearance and give it a more penetrating odor. When combined with pus and detritus, its appearance and odor may become overwhelming and repulsive.

Primary inflammatory disease of the middle ear mainly causes pain. It is usually unilateral and appears to be severe. Hearing loss may also be experienced. If the inflammation is ruptured, there can be purulent discharge from the external ear canal.

An excessive buildup of earwax also can cause problems. Some signs and symptoms include:

• Dizziness
• Loss of hearing
• Nausea and vomiting
• Earache
• Bleeding or discharge from the ear
• Swelling or redness
• An object visible in the ear

Meatus occlusion, impaction, irritation, hearing loss, or otitis externa, and clinical inspection of the eardrum are all indications for removing wax. The simplest method would be to syringe the ear. Tap water at body temperature is used. The pinna is lifted to straighten the ear canal and the water jet is aimed at the roof of the canal, never directly at the eardrum. The canal and drum head must be examined later.

During the removal procedure, people having perforations should not have their ears syringed. The concerned doctor may also use a small plastic spoon which is known as a curette, for the removal.

In difficult or refractory cases, a microscope and sucker may be used in outpatients or under general anesthesia. Hard impacted wax may need to be softened with topical ceruminolytic ear drops prior to removal.

Disclaimer: This post is for informative purposes only, and should not be used as a replacement for expert medical advice.