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Outer ear infection: What helps if earwax builds up?

Created: ; Last Update: November 30, 2017; Next update: 2020.

Various ear drops can soften earwax in the outer ear canal (external auditory 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 then formed from these secretions, together with 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. Some people, particularly men and older people, are more likely to have a build-up of earwax in their ear canal. As we get older, our ear wax changes, and that can cause problems. 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 ear wax may form and affect your hearing. Researchers 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 self-cleaning ability. Cleaning your ears with cotton buds, hair pins or similar objects may cause problems too. This is because doing so only removes some of the earwax – the rest is pushed further into the ear, where it becomes harder and forms a plug. Cleaning your ears in this way can also irritate or injure the eardrum or the skin lining the outer ear canal.

Hearing aids or headphones that are placed inside your ears ("in-ear headphones") may also cause earwax to build up and harden if used too often. Wearing ear plugs to shut out noise, dust or water can have this effect too.

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: 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.
  • Syringing or irrigation: This is done by a doctor, and involves rinsing out the ear.
  • Special instruments that a doctor can use to suck out the earwax or clean the outer ear canal.

Before using irrigation to remove earwax, you can try out cerumenolytics first. If they don't get rid of earwax, they can still help to prepare for irrigation. Irrigation isn't always suitable – particularly in people who have a damaged eardrum or a middle ear infection. An ear, nose and throat (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.

But most studies only looked at a small number of people, and some had other weaknesses as well. So there are no clear answers yet. Overall, though, it seems safe to say that cerumenolytics and oils can effectively remove earwax. Using cerumenolytics before doing an ear irrigation can improve the treatment outcome.

Other researchers, including researchers from the Cochrane Collaboration (an international research network) also looked at studies on different types of ear drops. Their findings were similar: Ear drops can help, but it's not clear whether certain types work better than others.

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 different 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 outer ear infections (otitis externa).

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.


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Bookshelf ID: NBK279354


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