Dr Margaret answers emailers’ embarrassing problems
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Earwax

Dear Dr Margaret
Why do I keep having earwax problems? My wife never has this trouble.

We all produce earwax all the time. The earhole is lined with a special type of skin and, like skin elsewhere, it is constantly renewing itself. This means that dead cells at the surface drop off. The skin of the earhole also contains tiny glands, which produce oily secretions. Earwax is usually about 60% dead cells, mixed with oily secretions from the glands. In some people, the wax is ‘dry’, which means that it is greyish or light brown colour and has a brittle texture. This type of wax contains a smaller amount of oily substances than ‘wet’ wax, which is light or dark brown and sticky.

The wax gets rid of dead cells from the skin of the earhole. It also cleans the earhole by trapping dirt. It used to be thought that earwax acted as a natural antibiotic, protecting the inside of the ear from infection, but this does not seem to be the case. In fact, scientists have found over 300 types of bacteria growing happily in earwax.

Problems with earwax
In the UK alone, 4 million ears are syringed each year, so a lot of people have an ear wax problem. You do not say what your problem is, but the most common is loss of hearing. Wax can sometimes cause other problems, such as dizziness or tinnitus (sounds within the ear). I can not answer your question about why you have a greater problem than other people. It could be that you naturally produce more wax. Scientists also think that, in some people, the surface of the skin within the earhole tends to hold onto dead cells and secretions more than in other people, so it accumulates as a lump.

What to do
The first thing is to check with your doctor that wax is the cause of whatever symptoms you are experiencing; do not assume that all ear problems are due to wax. If it is wax, doing nothing is a possibility because there is a 1 in 20 chance that a wax blockage will clear naturally, without any treatment. Do not poke anything (including cotton wool buds) in your ear to try to remove the wax blockage – you will push the wax further in, and could perforate your eardrum.

You can buy wax-removing drops from pharmacies. These work by softening (hydrating) the waxy lump, and breaking down the old skin cells that it contains. It is difficult to know which types are best, because few good scientific studies have compared them. Probably, they are all roughly similar in effectiveness, but the non-water, non-oil-based type may be slightly better. These drops contain 5% urea-hydrogen peroxide, or 50% choline salicylate with glycerol. Check the label or ask the pharmacist. It might be a good idea to use the drops once or twice a year to prevent wax building up in future.

When you put the drops in, lie down for a while on your opposite side, to enable the drops to soak into the wax. If you stand up, the drops may simply run out of the ear. This is why it makes sense to apply the drops at bedtime. You must use the drops for several days, so do not expect immediate results

If drops do not work, the only alternative is to visit your doctor for removal of the wax, usually by syringing, but sometimes with an instrument (curetting). Doctors are not very keen on syringing because, although it is usually a safe procedure, it can occasionally cause problems, such as perforation of the eardrum, painful inflammation of the earhole or infection of the outer ear. If you have diabetes, or an illness in which your immune system is low, you should probably not have your ears syringed, as you are more likely to develop an ear infection afterwards.

Sources of information
Guest JF, Greener MJ, Robinson AC, Smith AF. Impacted cerumen: composition, production, epidemiology and management. Quarterly Journal of Medicine 2004;97:477–88.

Hand C, Harvey I. The effectiveness of topical preparations for the treatment of earwax: a systematic review. British Journal of General Practice 2004;54:862–7.

Treating earwax. Bandolier 2005.
www.jr2.ox.ac.uk/bandolier/band130/b130-2.html

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