Earwax: Too Much of a Good Thing?

Anatomy of an Ear Infection Slideshow

New Guidelines Set for Safely Removing Excess Earwax

By Kelley Colihan
WebMD Health News

Reviewed By Louise Chang, MD

Aug. 29, 2008 — The body is a miraculous mechanism. Consider the once-lowly earwax. People used to try to remove it. Now, we now know that earwax has a job to do.

Think of it kind of like the oil in your car, except it doesn't ever have to be changed.

Earwax is created by a mixture of secretions from glands that line the ear canal, sloughed-off skin cells, and bits of hair.

It acts as a cleaning agent, which also protects and lubricates part of the sensitive ear canal.

Normally, excess wax eases its way out of your ear without any prompting on your part, helped along by the movement of your jaw.

That's when it can be cleaned out a bit, but it's advised that you not go looking for it and only clean out earwax once it emerges on its own.

So, although earwax is essentially good, too much of it can cause problems.

The American Academy of Otolaryngology — Head and Neck Surgery Foundation are releasing the national guidelines to help clinicians recognize earwax buildup, find the best ways to remove earwax, and deal with patients when earwax becomes a problem. The guidelines do not apply to earwax impaction related to certain conditions, such as skin diseases of the ear.

The clinical term for earwax is cerumen.

"Approximately 12 million people a year in the U.S. seek medical care for impacted or excessive cerumen," according to news release comments from Richard Rosenfeld, MD, who led the Guideline Development Task Force.

He says nearly 8 million cerumen-removal procedures are performed yearly by health care professionals. "Developing practical clinical guidelines for physicians to understand the harm vs. benefit profile of the intervention was essential," Rosenfeld says.

The panel that created the guidelines was drawn from a pool of specialists in audiology, family medicine, geriatrics, internal medicine, nursing, surgeons, and pediatrics.

Here are some of the guidelines' highlights:

• The panel made a "strong" recommendation that doctors should "treat" impacted earwax when it causes symptoms or gets in the way of an examination.

Symptoms of too much earwax:

• Pain, itching of the ear, ringing of the ears (tinnitus), or hearing loss.

How do professionals remove it? One way is with irrigation, gently letting water wash out the excess wax.

• It is also recommended that doctors get into the habit of asking patients about their earwax history.
• People with hearing aids are advised to get checked regularly for ear wax buildup. This can help maintain hearing aid function and lower risk of damage to the hearing aid.
• It is "strongly advised" that people not use cotton swabs or ear candling to clean earwax on their own.
• Those who are high-risk for impacted earwax are advised to get checked every 6- to 12 months for routine cleaning.

In prepared comments, the panel's lead author Peter Roland, MD, said, "The complications from cerumen impaction can be painful and ongoing, including infections and hearing loss."

He added, "It is hoped that these guidelines will give clinicians the tools they need to spot an issue early and avoid serious outcomes."

The guidelines are published in the September issue of Otolarynology-Head and Neck Surgery.

SOURCES: Roland, P. Otolaryngology-Head and Neck Surgery, September 2008. News release, American Academy of Otolaryngology.

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