Earwax, also known by the medical term cerumen, is a brown, orange, red, yellowish or gray waxy substance secreted in the

ear canal The ear canal (external acoustic meatus, external auditory meatus, EAM) is a pathway running from the outer ear to the middle ear. The adult human ear canal extends from the pinna (anatomy), pinna to the eardrum and is about in length and in di ...

of humans and other mammals. It protects the skin of the human ear canal, assists in cleaning and lubrication, and provides protection against

bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were am ...

fungi A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately fr ...

, and water. Earwax consists of dead skin cells, hair, and the secretions of cerumen by the ceruminous and

sebaceous gland A sebaceous gland is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur in the greatest n ...

s of the

outer {{Short pages monitor Movement of the jaw helps the ears' natural cleaning process. The

American Academy of Otolaryngology American(s) may refer to: * American, something of, from, or related to the United States of America, commonly known as the "United States" or "America" ** Americans, citizens and nationals of the United States of America ** American ancestry, pe ...

discourages earwax removal, unless the excess earwax is symptomatic. While a number of methods of earwax removal are effective, their comparative merits have not been determined. A number of softeners are effective; however, if this is not sufficient, the most common method of cerumen removal is syringing with warm water. A curette method is more likely to be used by

audiologist Audiology (from Latin , "to hear"; and from Greek , ''-logia'') is a branch of science that studies hearing, balance, and related disorders. Audiologists treat those with hearing loss and proactively prevent related damage. By employing vario ...

s and

otolaryngologists Otorhinolaryngology ( , abbreviated ORL and also known as otolaryngology, otolaryngology–head and neck surgery (ORL–H&N or OHNS), or ear, nose, and throat (ENT)) is a surgical subspeciality within medicine that deals with the surgical a ...

when the ear canal is partially occluded and the material is not adhering to the skin of the ear canal. Cotton swabs, on the other hand, push most of the earwax farther into the ear canal and remove only a small portion of the top layer of wax that happens to adhere to the fibers of the swab.

Softeners

This process is referred to as ''cerumenolysis''. Topical preparations for the removal of earwax may be better than no treatment, and there may not be much difference between types, including water and olive oil. However, there were not enough studies to draw firm conclusions, and the evidence on irrigation and manual removal is equivocal. Commercially or commonly available cerumenolytics include: * Any of a number of types of oil * Urea hydrogen peroxide (6.5%) and

glycerine Glycerol (), also called glycerine in British English and glycerin in American English, is a simple triol compound. It is a colorless, odorless, viscous liquid that is sweet-tasting and non-toxic. The glycerol backbone is found in lipids know ...

* A solution of

sodium bicarbonate Sodium bicarbonate ( IUPAC name: sodium hydrogencarbonate), commonly known as baking soda or bicarbonate of soda, is a chemical compound with the formula NaHCO3. It is a salt composed of a sodium cation ( Na+) and a bicarbonate anion ( HCO3− ...

in water, or sodium bicarbonate B.P.C. (sodium bicarbonate and glycerine) * Cerumol (

peanut oil Peanut oil, also known as groundnut oil or arachis oil, is a vegetable oil derived from peanuts. The oil usually has a mild or neutral flavor but, if made with roasted peanuts, has a stronger peanut flavor and aroma. It is often used in Americ ...

turpentine Turpentine (which is also called spirit of turpentine, oil of turpentine, terebenthene, terebinthine and (colloquially) turps) is a fluid obtained by the distillation of resin harvested from living trees, mainly pines. Mainly used as a special ...

and dichlorobenzene) * Cerumenex (

triethanolamine Triethanolamine, or TEA is a viscous organic compound that is both a tertiary amine and a triol. A triol is a molecule with three alcohol groups. Approximately 150,000 tonnes were produced in 1999. It is a colourless compound although samples m ...

polypeptide Peptides (, ) are short chains of amino acids linked by peptide bonds. Long chains of amino acids are called proteins. Chains of fewer than twenty amino acids are called oligopeptides, and include dipeptides, tripeptides, and tetrapeptides. ...

s and oleate-condensate) *

Docusate Docusate is the common chemical and pharmaceutical name of the anion bis(2-ethylhexyl) sulfosuccinate, also commonly called dioctyl sulfosuccinate (DOSS). It is on the World Health Organization's List of Essential Medicines. Salts of this anio ...

, an emulsifying agent, an active ingredient found in

laxative Laxatives, purgatives, or aperients are substances that loosen stools and increase bowel movements. They are used to treat and prevent constipation. Laxatives vary as to how they work and the side effects they may have. Certain stimulant, lubri ...

s * Mineral oil A cerumenolytic should be used 2–3 times daily for 3–5 days prior to the cerumen extraction.

Microsuction

Microsuction involves the use of a vacuum suction probe to break up and extract impacted cerumen. Microsuction can be preferred over other methods as it avoids the presence of moisture in the ear, is often faster than irrigation, and is performed with direct vision of the earwax being removed. Typically, a camera with lights and guide hole is utilised, with a long metal vacuum probe being inserted into the guide hole - the practitioner is then able to see inside the ear and remove earwax under pressure. Potential adverse effects include dizziness, temporary tinnitus, and reduced hearing due to volume of the pump and the proximity of the vacuum probe to the ear drum - the frequency of these are reduced where the cerumen is softened in the five days preceding microsuction. In general, microsuction is well tolerated and even preferred by many patients.

Ear irrigation

Once the cerumen has been softened, it may be removed from the ear canal by irrigation, but the evidence on this practice is equivocal. This may be effectively accomplished with a spray type ear washer, commonly used in the medical setting or at home, with a bulb

syringe A syringe is a simple reciprocating pump consisting of a plunger (though in modern syringes, it is actually a piston) that fits tightly within a cylindrical tube called a barrel. The plunger can be linearly pulled and pushed along the inside ...

. Ear syringing techniques are described in great detail by Wilson & Roeser and Blake et al. who advise pulling the external ear up and back, and aiming the nozzle of the syringe slightly upwards and backwards so that the water flows as a cascade along the roof of the canal. The irrigation solution flows out of the canal along its floor, taking wax and debris with it. The solution used to irrigate the ear canal is usually warm water, normal saline, sodium bicarbonate solution, or a solution of water and

vinegar Vinegar is an aqueous solution of acetic acid and trace compounds that may include flavorings. Vinegar typically contains 5–8% acetic acid by volume. Usually, the acetic acid is produced by a double fermentation, converting simple sugars to eth ...

to help prevent secondary infection. Affected people generally prefer the irrigation solution to be warmed to body temperature, as

dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness. Dizziness is a common medical c ...

is a common side effect of ear washing or syringing with fluids that are colder or warmer than body temperature.

Curette and cotton swabs

Earwax can be removed with an

ear pick Ear picks, also called ear scoops, or ear spoons, or earpicks, are a type of curette used to clean the ear canal of earwax (cerumen). They are preferred and are commonly used in East Asia, South Asia and Southeast Asia because Asians tend to d ...

/curette, which physically dislodges the earwax and scoops it out of the ear canal. In the West, use of ear picks is usually only done by health professionals. Curetting earwax using an ear pick was common in

ancient Europe The expression Ancient Europe may be used in a variety of senses: *The ancient concept of ''Europa'' in Greek geography, in origin "the landmass adjacent to Thrace" ** Europa (ancient geography) **Europa (Roman province), in the Diocese of Thrace * ...

and is still practised in

East Asia East Asia is the eastern region of Asia, which is defined in both geographical and ethno-cultural terms. The modern states of East Asia include China, Japan, Mongolia, North Korea, South Korea, and Taiwan. China, North Korea, South Korea ...

. Since the earwax of most Asians is of the dry type, it is extremely easily removed by light scraping with an ear pick, as it simply falls out in large pieces or dry flakes. It is generally advised not to use cotton swabs (Q-Tips or cotton buds), as doing so will likely push the wax farther down the ear canal, and if used carelessly,

perforate A perforation is a small hole in a thin material or web. There is usually more than one perforation in an organized fashion, where all of the holes collectively are called a ''perforation''. The process of creating perforations is called perfor ...

the

eardrum In the anatomy of humans and various other tetrapods, the eardrum, also called the tympanic membrane or myringa, is a thin, cone-shaped membrane that separates the external ear from the middle ear. Its function is to transmit sound from the ...

. Abrasion of the ear canal, particularly after water has entered from swimming or bathing, can lead to ear infection. Also, the cotton head may fall off and become lodged in the ear canal. Therefore, cotton swabs should be used only to clean the external ear.

Ear candles and vacuuming

Ear candling Ear candling, also called ear coning or thermal-auricular therapy, is a pseudoscientific alternative medicine practice claiming to improve general health and well-being by lighting one end of a hollow candle and placing the other end in the ear c ...

, also called ear coning or thermal-auricular therapy, is an

alternative medicine Alternative medicine is any practice that aims to achieve the healing effects of medicine despite lacking biological plausibility, testability, repeatability, or evidence from clinical trials. Complementary medicine (CM), complementary and al ...

practice claimed to improve general health and well-being by lighting one end of a hollow

candle A candle is an ignitable wick embedded in wax, or another flammable solid substance such as tallow, that provides light, and in some cases, a fragrance. A candle can also provide heat or a method of keeping time. A person who makes candle ...

and placing the unlit end in the

. It, however, is not recommended as it is dangerous, ineffective, and counterproductive. Advocates say that the dark residue that shows after the procedure consists of extracted earwax, proving the efficacy of the procedure. Studies have shown that the same dark residue is left, whether or not the candle (which is made of cotton fabric and beeswax and leaves a residue after burning) is inserted into an ear. This demonstrates that the waxy residue is derived from the burnt candle wax itself and not the ear. The color of the candle wax matches the light brown-colored wax of the human ear, making the distinction between the two waxes more difficult for a layperson. Because the candle itself is a hollow tube, some of the hot burnt wax could drop down inside the candle, into the ear canal, potentially injuring the eardrum. The

states that ear candles are not a safe option for removing ear wax, and that no controlled studies or scientific evidence support their use for ear wax removal. Survey responses from medical specialists (otolaryngologists) in the United Kingdom reported ear injuries from ear candling including; burns, ear canal occlusions and ear drum perforations and secondary ear canal infections with temporary hearing loss. The

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

has successfully taken several regulatory actions against the sale and distribution of ear candles since 1996, including seizing ear candle products and ordering injunctions. They are now marked as "providing no health benefit". Home "ear vacs" were ineffective at removing ear-wax, especially when compared to a Jobson-Horne probe.

Potential complications

A postal survey of British general practitioners found that only 19% always performed cerumen removal themselves. It is problematic as the removal of cerumen is not without risk, and physicians and nurses often have inadequate training for removal. Irrigation can be performed at home with proper equipment as long as the person is careful not to irrigate too hard. All other methods should be carried out only by individuals who have been sufficiently trained in the procedure. The author Bull advised physicians: "After removal of wax, inspect thoroughly to make sure none remains. This advice might seem superfluous, but is frequently ignored." This was confirmed by Sharp et al., who, in a survey of 320 general practitioners, found that only 68% of doctors inspected the ear canal after syringing to check that the wax was removed. As a result, failure to remove the wax from the canal made up approximately 30% of the complications associated with the procedure. Other complications included otitis externa (swimmer's ear), which involves inflammation or bacterial infection of the external acoustic meatus, as well as

pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

vertigo Vertigo is a condition where a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea, vomiting, sweating, or difficulties w ...

tinnitus Tinnitus is the perception of sound when no corresponding external sound is present. Nearly everyone experiences a faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearin ...

, and perforation of the ear drum. Based on this study, a rate of major complications in 1/1000 ears syringed was suggested. Claims arising from ear syringing mishaps account for about 25% of the total claims received by New Zealand's Accident Compensation Corporation ENT Medical Misadventure Committee. While high, this is not surprising, as ear syringing is an extremely common procedure. Grossan suggested that approximately 150,000 ears are irrigated each week in the United States, and about 40,000 per week in the United Kingdom. Extrapolating from data obtained in Edinburgh, Sharp et al. place this figure much higher, estimating that approximately 7000 ears are syringed per 100,000 population per annum. In the New Zealand claims mentioned above, perforation of the tympanic membrane was by far the most common injury resulting in significant disability.

Prevalence

The prevalence of impacted earwax is different across the world. In the United Kingdom 2 to 6% of the population have cerumen that is impacted. In America 3.6% of emergency visits caused by ear issues were due to impacted cerumen. In Brazil 8.4–13.7% of the population have impacted cerumen.

History

The treatment of excess ear wax was described by

Aulus Cornelius Celsus Aulus Cornelius Celsus ( 25 BC 50 AD) was a Roman encyclopaedist, known for his extant medical work, ''De Medicina'', which is believed to be the only surviving section of a much larger encyclopedia. The ''De Medicina'' is a primary source on ...

in ''

De Medicina ''De Medicina'' is a 1st-century medical treatise by Aulus Cornelius Celsus, a Roman encyclopedist and possibly (but not likely) a practicing physician. It is the only surviving section of a much larger encyclopedia; only small parts still survi ...

'' in the 1st century:

Uses

*In medieval times, earwax and other substances such as

urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excreted from the body through the urethra. Cellul ...

were used to prepare

pigment A pigment is a colored material that is completely or nearly insoluble in water. In contrast, dyes are typically soluble, at least at some stage in their use. Generally dyes are often organic compounds whereas pigments are often inorganic compou ...

s used by

scribe A scribe is a person who serves as a professional copyist, especially one who made copies of manuscripts before the invention of automatic printing. The profession of the scribe, previously widespread across cultures, lost most of its promi ...

s to illustrate

illuminated manuscript An illuminated manuscript is a formally prepared document where the text is often supplemented with flourishes such as borders and miniature illustrations. Often used in the Roman Catholic Church for prayers, liturgical services and psalms, th ...

s. *

Pliny the Elder Gaius Plinius Secundus (AD 23/2479), called Pliny the Elder (), was a Roman author, naturalist and natural philosopher, and naval and army commander of the early Roman Empire, and a friend of the emperor Vespasian. He wrote the encyclopedic ' ...

, in his '' Natural History'', wrote that earwax—when applied topically—cured bites from humans, scorpions, and serpents; it was said to work best when taken from the ears of the wounded person itself. *The first

lip balm Lip balm or lip salve is a wax-like substance applied topically to the lips to moisturize and relieve chapped or dry lips, angular cheilitis, stomatitis, or cold sores. Lip balm often contains beeswax or carnauba wax, camphor, cetyl alcoho ...

may have been based on earwax. The 1832 edition of the ''American Frugal Housewife'' said that "nothing was better than earwax to prevent the painful effects resulting from a wound by a nail rskewer"; and also recommended earwax as a remedy for cracked lips. *Before waxed thread was commonly available, a seamstress would use her own earwax to stop the cut ends of threads from fraying.

Notes

External links

*Keeping the ear clean and removing wax
Fact Sheet
a
PubMed HealthClinical practice guideline: Cerumen impaction (The American Academy of Otolaryngology – Head and Neck Surgery)
{{Authority control Secretion Ear Waxes