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Otitis externa: What can help if earwax builds up?

Last Update: September 10, 2014; Next update: 2017.

Various ear drops can soften earwax in the outer ear canal (external auditory canal) and make it easier to remove. Yet home remedies like warmed olive oil could also work just as well.

Earwax plays an important role in how the outer ear canal cleans itself. The outer ear canal connects the outside visible part of our ear with the eardrum. Dirt can enter the outer ear canal, but most deposits in the ear are made up of tiny dead skin particles. It is quite normal for the skin to keep renewing itself through constant shedding.

The ceruminous glands (Glandulae ceruminosae) secrete lipids and other substances that serve to clean the external auditory canal. These secretions keep the skin of the auditory canal lubricated and maintain its acidic protective layer. This acid environment 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. When we speak and eat, for instance, the earwax is constantly pushed towards the outer ear by the natural movement of our lower jaw, which helps to keep our ears clean.

What causes earwax plugs?

The amount of earwax produced varies from person to person and has nothing to do with personal hygiene. Some people – mostly men and older people– produce a lot of earwax. Too much earwax can cause problems in older people. Less secretion is produced by the ceruminous glands as they start to shrink, causing the earwax to dry out. Dead skin particles continue to build up, and because the earwax is so dry the ear’s ability to clean itself is less effective.

When a lot of earwax is produced or if earwax builds up in the ear canal, it may form a plug that can affect your hearing. Researchers estimate that removing an earwax plug can improve hearing by 10 decibels. The difference between quiet whispering and normal conversation is about 20 decibels.

There are also other things that can make it difficult for the ear’s self-cleaning process to work right besides getting older. Cleaning your ears with cotton swabs, hair pins, keys or similar utensils may cause problems because even though some of the dead skin particles and earwax are removed, the rest is pushed deeper into the ear so that it hardens and forms a lump At the same time there is a risk of injuring the eardrum or the skin of the outer ear canal.

Putting miniature speakers in your ears (in-ear headphones or hearing aids) or wearing ear plugs to shut out noise, dust or water can also cause earwax to build up and harden if used too often.

How to remove earwax

You can remove normal amounts of earwax in and around the outer ear by using a soft washcloth or facial tissue after washing or taking a shower. There are different ways to remove larger amounts of earwax from the outer ear canal or to remove an earwax plug:

  • Warmed olive oil, almond oil, water or special ear drops or sprays (cerumenolytics): They can soften the earwax, which can then leave the ear more easily.
  • Irrigation: A stream of water is used to rinse out the ear.
  • Special instruments that a doctor can use to vacuum the earwax or clean it from the outer ear canal.

Cerumenolytics are commonly tried before resorting to ear irrigation. If this does not help, cerumenolytics can also be used to prepare for irrigation. Irrigation and other mechanical methods for removing earwax are not suitable for people who have a middle ear infection, however. Eardrum injuries, recurring ear infections or other problems are also all possible reasons to avoid irrigation.

Which method is most effective?

To find the most effective method for removing earwax, researchers from the University of Southampton in Great Britain looked for studies testing different ways of removing earwax. The researchers found a total of 22 randomized controlled trials that tested many different types of treatments, but most studies only examined a small number of people and some had other weaknesses as well. So there are no definite answers yet. But overall, the researchers concluded that cerumenolytics or oils can solve the problem on their own. Using cerumenolytics before ear irrigation can also improve the result of treatment.

Researchers from the Cochrane Collaboration – an international research network – also looked at studies on different types of ear drops. Both groups of researchers came to the same conclusion: Ear drops do work, but it is not clear whether there is a particular type that is proven to work better than others.

In addition to cerumenolytics, sometimes complementary or alternative therapies are also used, for example ear candles. These candles are placed in the ear canal and then lit on the other end. There is no scientific proof that the warm air rising inside of the ear candle will dissolve any earwax or help remove it. The U.S. regulatory authority FDA issued a public warning that the use of ear candles can lead to serious ear injuries.

Side effects

Most of the studies looking at side effects of ear drops found either no or only rare side effects, mainly itching, dizziness, skin irritations, and inflammation of the outer ear canal (otitis externa).

The outer ear canal can also become inflamed after earwax has been removed with cotton swabs or sharp instruments. Removing earwax also means losing the protection that the earwax offers.

Eardrum injuries resulting from irrigation are rare if it is done by a doctor.

Sources

  • Burton MJ, Doree C. Ear drops for the removal of ear wax. Cochrane Database Syst Rev 2009; (1): CD004326. [PubMed: 12918014]
  • Clegg AJ, Loveman E, Gospodarevskaya E, Harris P, Bird A et al. The safety and effectiveness of different methods of earwax removal: a systematic review and economic evaluation. Health Technol Assess 2010; 14(28): 1-192. [PubMed: 20546687]
  • US Food and Drug Administration (FDA). Advice for patients: Ear candles. March 2013.
  • IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

    Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

    Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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IQWiG (Institute for Quality and Efficiency in Health Care)

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