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Cerumen (Wax)

General information

• Cerumen is a word derived from the Latin cera, or wax. Wax in the ear is a perfectly normal condition. Wax is usually soft, varies in color from almost white to dark brown, and serves to trap small particles, which may enter the ear. Part of the canal is lined with fine hairs (cilia) that also help to trap particles that propel wax toward the ear opening where it can be washed off.
• In some individuals the wax does not move out of the ear properly because of overproduction and/or drying of wax, a narrowed opening, and/or excessive hair in the canal. Wax can also become hardened and impacted in the ear, and may press against the sensitive inner two-thirds of the ear canal, causing pain.
• If you get water in your ear while bathing or swimming, the wax may trap the water inside the ear, which can result in a skin infection.
• Many incidents of impacted wax are self-induced. Cleaning your ears with cotton swabs will push any collection of wax down against the eardrum, causing it to be impacted.
• Impacted wax may cause a reduction in hearing, since sound waves cannot get past the wax to the eardrum. There may also be slight pain or dizziness.

Signs and symptoms of wax build-up

• partial hearing loss
• ringing in an ear or ears
• earache
• sensation that the ears are plugged

Treatment

• Inform your health care provider if you have any ear discharge, known eardrum perforation, or symptoms of nasal congestion before having any wax blockage cleared. The removal procedures could cause the eardrum to become perforated, possibly leading to a middle ear infection.
• Your health care provider will remove the wax blockage by warm water irrigation or using a small tool known as a curette to scoop the wax from the ear canal.
• If irrigation is unsuccessful, your health care provider may ask you to use a wax softener to soften the wax blockage before another irrigation is attempted.
• If the canal and/or the eardrum is bright red once the wax is removed, your health care provider may prescribe a systemic or topical antibiotic and have you return for a recheck within a few days.
• Do not use ear candles to assist in removing the wax. They can cause burns to the ear canal or ear drum.

Self care

In some patients with recurring ear wax impaction, self-administration of softening drops and gentle irrigation with a bulb syringe or water pick (on slow speed) can be done. Your health care provider can give you instructions and recommendations.

Notify your provider if:

• dizziness occurs with the removal of the cerumen
• hearing loss persist after removal of the cerumen
• pain persists longer than one hour after removal of the cerumen
• you notice pus or blood draining from the canal after removal of the cerumen

References

Dinces, E. A. Cerumen. UpToDate.
Pray, W. Steven Ph.D., D.Ph. and Joshua J. Pray, Pharm D. (2005) Medscape.com Earwax: Should it be Removed?