Earwax is a mixture of the shed out skin cells and hair combined with the secretions of both the ceruminous and the sebaceous glands of the external ear canal. There have been a number of studies to identify the composition of earwax. If you must know- they use a combination analytical technique such as gas chromatography and mass spectrometry to do this. Most studies indicate that the major organic components of earwax are fatty acids (both saturated and unsaturated), alcohols, squalene, and cholesterol. There are usually some foreign substances within earwax.

Earwax has special properties to trap germs going into the ear and kill them via special enzymes. Therefore, when formed in a limited amount, it is actually a good thing to have a little bit of earwax than not.

Our body has natural mechanisms to remove wax. Firstly, the skin of the ear canal acts like a conveyor belt and migrates from inside out at a rate of 1-2 mm per day (yes, somebody had the patience to measure it!). Also, when we move our jaw while chewing or eating etc, the pressure inside the ear canal changes which helps to migrate wax outside.

Earwax becomes an issue when it clogs the ear canal. This can cause various symptoms such as itching, irritation, tinnitus (ringing/buzzing in the ears), hearing loss and sometimes infections.

(Note there is a picture of ear burn below. Please skip this question, if you find these things distressing)

Ear candles, also known as hopi candles, are hollow tubes coated in wax which are inserted into patients' ears and then lit at the far end. The procedure is used as a complementary therapy for a wide range of conditions. A critical assessment of the evidence shows that its mode of action is implausible and demonstrably wrong. There are no data to suggest that it is effective for any condition. Furthermore, ear candles have been associated with ear injuries. The inescapable conclusion is that ear candles do more harm than good. Their use should be discouraged.

UK Ear Specialists advise against the use of Hopi Candles and FDA is warning people not to use them because they can cause serious injury. Ear candles are promoted and sold in health food stores, health spas and salons, flea markets and on the Internet. In our experience, the wax you see after the candle treatment is actually the wax from candles themselves rather than wax coming out from your ears. Check this FDA warning in this youtube video​:

https://youtu.be/9ZwkZUrtJmg?si=PsBMzVhe2i1bMhZv

FDA has received reports of burns, perforated eardrums and blockage of the ear canal which required outpatient surgery from the use of ear candles.

Below is one such rather grim case of a 50 year old woman, who unfortunately burned her ear from a hopi candle, reported in a scientific publication

One of our colleagues has also made this video reiterating how ineffective and counterproductive the ear candles are.

In the 30 years leading to 2010, more than 260,000 children visited US emergency department due to injuries related to use of cotton buds. Around 55% of them had either a hole in the eardrum or foreign body sensation. (Ameen et al, 2017)​.

Charlton and Rejali, 2019 reported a young 31 year old man who used cotton bud in his ear that got stuck inside without his knowledge, causing serious damage in the bones around the ear. Of course the ear is only separated from the brain by a very thin bone and the infection reached the part of the brain just above the ear. A bit of cotton left in the ear may sound harmless, but in this case, it wreaked havoc​.

There are numerous other examples that we have from our own clinic, where earbuds have done much more damage than good. We put it to you that there is no wisdom in poking your ears whatsoever. In fact, the boxes of earbuds do come with a warning NOT to use them in the ears.​

still, in a survey in South East England, it was found that an alarming 68% people were using cotton buds in their ears, with 76% of users using them at least weekly, if not more frequently. The primary reason (96%) given for using cotton buds was to remove earwax. 

Here are the top reasons why it is not a great idea:

• Cotton buds can cause the wax to be pushed further inside, even when you are careful. This makes the ear more waxy, not less.
• Cotton buds can cause blunt trauma in the ear, which can cause infection and pain.
• Cotton buds might help remove a protective layer of protein from the ear canal, making the skin more sensitive to wind etc as you grow older.
• Cotton buds may help introducing germs into the ear as they have surface bacteria and other harmful germs, which get introduced in the ear.
• Cotton is a good absorber of water and oil. It removes the natural moisture from the ear canal, making it dry, itchy and even more waxy.​

Therefore, the old adage that nothing smaller than your elbow goes in the ear, is a golden piece of wisdom. Yes, this includes hairpins, tweezers, straws, paper clips, pen, pencils and every other inanimate object that you use to clean your ears.

There are a plenty of ear drops available over-the counter, but it appears that normal olive oil (NOT extra virgin variety), and 5% sodium bicarbonate ear drops are two safest options, with no known side effects after short-term use.

However, every feeling of blockage is not due to ear wax. We see people in our clinic with acute medical issues that are deemed due to earwax but need urgent help. Take expert advice before using the ear drops.​

Ear drops can sometime cause a few problems e.g. olive oil can cause issues if you have skin conditions such as allergy, dry skin and/or Psoriasis. General contraindications of this sort of wax treatment include (but NOT limited to)-perforated eardrum, inflammation, recent ear surgery, injury or infection, and mastoid cavity. Also, how accurately you can get the drops into the wax in the ear, is also a factor in their effectiveness​. Finally, sometime the eardrops make the wax too soft, which slides down on the eardrum when you lie down or sleep on your side (due to the gravity pulling the wax down). This makes your symptoms worse and makes it even more difficult to remove the wax from the ear.

Therefore, it is perhaps prudent to seek advice before you use any ear drops.

Firstly, if you need to itch just itch the ear from outside. Again, don’t put anything inside the ear.​

Seek professional help- it will be better, safer and cheaper option. There are tons of reasons why ears become waxy/itchy. So, visit someone who knows what they are doing and can treat your specific problem. GP, ENT, Nurse or audiologists- they are available near you so, just make that visit.​ Book an appointment with us to fix it, if you are able to access one of our clinical sites.