The ear: How can you keep it clean and what helps if earwax builds up?

Various ear drops can soften earwax and make it easier to remove. Yet home remedies like warmed olive oil could also work just as well or almost just as well.

Earwax is important to the self-cleaning of the external auditory canal (outer ear canal). The external auditory canal is located between the auricle and the eardrum of the human ear. You can find more information about the structure and the functioning of the human ear here (URL: http://www.informedhealthonline.org/here.370.en.html) . Impurities can enter the external auditory canal; but most of these deposits in the ear are made up of tiny dead skin particles. It is quite normal for the skin to keep renewing itself by constant shedding.

The natural cleaning of the external auditory canal from these skin flakes happens in two ways: The so-called ceruminous glands (glandulae ceruminosae) secrete lipids and other substances in the ear. This secretion helps to protect the skin of the auditory canal by keeping it lubricated. This also maintains the skin’s protective acid mantle that protects the auditory canal from infection by killing bacteria and fungi. Earwax is then formed from these secretions, together with shed skin flakes and dust particles. The medical term for earwax is cerumen.

The ear also cleans itself by movement. When we speak and eat, for instance, the earwax is constantly pushed by the natural movement of our lower jaw towards the outer ear, thereby supporting the self-cleaning of our ears.

Why earwax is produced

Earwax can vary considerably from person to person – for example, as regards color and amount. The amount of earwax has nothing to do with personal hygiene. Some people – mostly men and old people– produce a lot of earwax. Another reason why earwax often becomes a problem in old age: the ceruminous glands start to shrink, making the earwax dry. But because dead skin particles continue to build up, the self-cleaning of the external auditory canal no longer works as well as it does in younger people.

When too much earwax is produced or the earwax is no longer properly pushed out of the ear, a plug may form that can impair hearing. Researchers estimate that removing an earwax plug like this can improve hearing by 10 decibels, which already makes a difference. To compare: the difference between quiet whispering and normal conversation is about 20 decibels. You can read more about how hearing can be tested and measured here (URL: http://www.informedhealthonline.org/here.369.en.html) .

Increased build-up of earwax does not only result from normal ageing processes, but can also be caused by a hearing aid. And if you try to clean your ears with cotton swabs, hair pins or similar utensils, this can cause or worsen increased earwax build-up. The reason: It is indeed possible to remove some of the dead skin particles and earwax, but on the other hand, the earwax is also pushed deeper into the ear so that it hardens and forms a lump. At the same time there is a high risk of injuring the eardrum or the skin of the external auditory canal.

How to remove built-up earwax

You can remove normal amounts of earwax in and around the outer ear, usually after washing or showering, by using a soft washcloth or facial tissue. To remove larger amounts of earwax or to remove an earwax plug there are different options:

• Warmed olive oil, almond oil, water or special ear drops or sprays (so-called cerumenolytics) to loosen the plug. This can soften the earwax, which can then leave the ear more easily.
• Ear irrigation: a stream of water is used to rinse the ear.
• Special instruments that a doctor can use to vacuum the earwax or scrape it from the external auditory canal.

Cerumenolytics are commonly tried out before ear irrigation is carried out. If this does not help, cerumenolytics can also be used to prepare for irrigation. Irrigation and other mechanical methods for removing earwax are not appropriate for people who have a middle ear infection, however. Recurring ear infections, previous ear surgery or inflammation of the external auditory canal are also all reasons for not doing irrigation – as are eardrum injury and permanent ringing in the ears (tinnitus). Irrigation is also not advisable for people who have hearing in only one ear.

Sometimes a complementary therapy is also used, the so-called ear candles. These candles are placed in the auditory canal and then lit on the other end. The person is lying on their side so that warmed air is supposed to rise inside of the ear candle, dissolving any earwax and helping remove it. This effect is not scientifically proven, however. The US regulatory authority FDA issued a public warning in 2010 that the use of ear candles can lead to serious ear injuries.

Scientific testing of the most effective method

Researchers from the University of Southampton in Great Britain were asked to find trials testing different ways of removing earwax as part of the National Health Technology Assessment (HTA) program. These scientific studies were so-called randomized controlled trials, in which participants are randomly assigned to different treatment groups. The individual groups are then compared with one another – either two different treatments with each other or one treatment compared with no treatment. This procedure makes it possible to compare different treatments and to find out whether they have different effects. You can find more information about this type of comparative research here (URL: http://www.informedhealthonline.org/here.61.en.html) .

Researchers from the international research network Cochrane Collaboration also looked at trials of various types of ear drops. Both teams of researchers came to the same conclusion about ear drops: They do work, but it is not clear whether there is a certain type that is proven to work better than others.

The researchers from the University of Southampton found a total of 22 randomized trials. Most of these were small trials that tested many different types of treatments: there were no larger good-quality trials that would have been able to provide clear answers. Overall, they concluded that substances for dissolving earwax (cerumenolytics) can sometimes solve the problem on their own. Using cerumenolytics before doing ear irrigation can also at least improve the result of treatment.

In at least 2 trials several types of ear drops or sprays worked better than no treatment or alternative treatment. The trials examined used over-the-counter ear drops containing mostly two ingredients: triethanolamine polypeptide oleate condensate or urea-hydrogen peroxide. According to researchers’ conclusions sodium bicarbonate drops and other products could also be effective. One further result: having medical professionals irrigate the ear can be more effective than using special balloon-like ear syringes at home. However, more research is needed to be sure about which types of irrigation can better clean the auditory canal.

Adverse effects of the different methods

Adverse effects are rare when ear drops are used alone: Most of the trials that specifically studied adverse effects of ear drops found either no or only rare adverse effects: Less than 5% of the participants experienced adverse effects. These rare adverse effects included most commonly itchiness or dizziness. One possible cause of dizziness may be the application of ear drops that are too cold. Irritation and redness of the skin were somewhat more common when ear drops were used.

The adverse effects of ear irrigation were also studied: As long as the irrigations were not done on people who had other ear conditions (see the section “How to remove built-up earwax”), serious adverse effects are unlikely. In rare cases irrigations can lead to eardrum injury or permanent ringing in the ears (tinnitus). You can find out more about tinnitus here (URL: http://www.gesundheitsinformation.de/index.523.56.en.html) . These types of injuries are more likely to happen when ear irrigation is done on your own at home, for example by using an ear syringe. Injury to the eardrum during ear irrigation is nonetheless rare. It is more likely to be caused by attempting to clean the ear with cotton swabs or other utensils.

There can also be inflammation of the external auditory canal (otitis externa) after earwax has been removed. This may be caused by the loss of the protective function of the earwax or by injury to the ear during earwax removal.

Author: Institute for Quality and Efficiency in Health Care (IQWiG)

Next planned update: February 2014. You can find out more about how our health information is updated here (URL: http://www.gesundheitsinformation.de/index.643.en.html?bab[subpage_id]=0-8) .