Earwax

Earwax

Overview
Earwax, also known by the medical term cerumen, is a yellowish wax
Wax
thumb|right|[[Cetyl palmitate]], a typical wax ester.Wax refers to a class of chemical compounds that are plastic near ambient temperatures. Characteristically, they melt above 45 °C to give a low viscosity liquid. Waxes are insoluble in water but soluble in organic, nonpolar solvents...

y substance secreted in the ear canal
Ear canal
The ear canal , is a tube running from the outer ear to the middle ear. The human ear canal extends from the pinna to the eardrum and is about 35 mm in length and 5 to 10 mm in diameter....

 of humans and other mammals. It protects the skin of the human ear canal, assists in cleaning and lubrication, and also provides some protection from bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...

, fungi
Fungus
A fungus is a member of a large group of eukaryotic organisms that includes microorganisms such as yeasts and molds , as well as the more familiar mushrooms. These organisms are classified as a kingdom, Fungi, which is separate from plants, animals, and bacteria...

, insect
Insect
Insects are a class of living creatures within the arthropods that have a chitinous exoskeleton, a three-part body , three pairs of jointed legs, compound eyes, and two antennae...

s and water. Excess or impacted cerumen can press against the eardrum
Eardrum
The eardrum, or tympanic membrane, is a thin membrane that separates the external ear from the middle ear in humans and other tetrapods. Its function is to transmit sound from the air to the ossicles inside the middle ear. The malleus bone bridges the gap between the eardrum and the other ossicles...

 and/or occlude the external auditory canal and impair hearing
Hearing (sense)
Hearing is the ability to perceive sound by detecting vibrations through an organ such as the ear. It is one of the traditional five senses...

.

Excessive cerumen may impede the passage of sound
Sound
Sound is a mechanical wave that is an oscillation of pressure transmitted through a solid, liquid, or gas, composed of frequencies within the range of hearing and of a level sufficiently strong to be heard, or the sensation stimulated in organs of hearing by such vibrations.-Propagation of...

 in the ear canal, causing conductive hearing loss
Conductive hearing loss
Conductive hearing loss occurs when there is a problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane , or middle ear ....

.
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Unanswered Questions
Encyclopedia
Earwax, also known by the medical term cerumen, is a yellowish wax
Wax
thumb|right|[[Cetyl palmitate]], a typical wax ester.Wax refers to a class of chemical compounds that are plastic near ambient temperatures. Characteristically, they melt above 45 °C to give a low viscosity liquid. Waxes are insoluble in water but soluble in organic, nonpolar solvents...

y substance secreted in the ear canal
Ear canal
The ear canal , is a tube running from the outer ear to the middle ear. The human ear canal extends from the pinna to the eardrum and is about 35 mm in length and 5 to 10 mm in diameter....

 of humans and other mammals. It protects the skin of the human ear canal, assists in cleaning and lubrication, and also provides some protection from bacteria
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...

, fungi
Fungus
A fungus is a member of a large group of eukaryotic organisms that includes microorganisms such as yeasts and molds , as well as the more familiar mushrooms. These organisms are classified as a kingdom, Fungi, which is separate from plants, animals, and bacteria...

, insect
Insect
Insects are a class of living creatures within the arthropods that have a chitinous exoskeleton, a three-part body , three pairs of jointed legs, compound eyes, and two antennae...

s and water. Excess or impacted cerumen can press against the eardrum
Eardrum
The eardrum, or tympanic membrane, is a thin membrane that separates the external ear from the middle ear in humans and other tetrapods. Its function is to transmit sound from the air to the ossicles inside the middle ear. The malleus bone bridges the gap between the eardrum and the other ossicles...

 and/or occlude the external auditory canal and impair hearing
Hearing (sense)
Hearing is the ability to perceive sound by detecting vibrations through an organ such as the ear. It is one of the traditional five senses...

.

Signs and symptoms


Excessive cerumen may impede the passage of sound
Sound
Sound is a mechanical wave that is an oscillation of pressure transmitted through a solid, liquid, or gas, composed of frequencies within the range of hearing and of a level sufficiently strong to be heard, or the sensation stimulated in organs of hearing by such vibrations.-Propagation of...

 in the ear canal, causing conductive hearing loss
Conductive hearing loss
Conductive hearing loss occurs when there is a problem conducting sound waves anywhere along the route through the outer ear, tympanic membrane , or middle ear ....

. It is also estimated to be the cause of 60–80% of hearing aid
Hearing aid
A hearing aid is an electroacoustic device which typically fits in or behind the wearer's ear, and is designed to amplify and modulate sound for the wearer. Earlier devices, known as "ear trumpets" or "ear horns", were passive funnel-like amplification cones designed to gather sound energy and...

 faults.

Physiology


Cerumen is produced in the outer third of the cartilaginous
Cartilage
Cartilage is a flexible connective tissue found in many areas in the bodies of humans and other animals, including the joints between bones, the rib cage, the ear, the nose, the elbow, the knee, the ankle, the bronchial tubes and the intervertebral discs...

 portion of the human ear canal. It is a mixture of viscous secretion
Secretion
Secretion is the process of elaborating, releasing, and oozing chemicals, or a secreted chemical substance from a cell or gland. In contrast to excretion, the substance may have a certain function, rather than being a waste product...

s from sebaceous gland
Sebaceous gland
The sebaceous glands are microscopic glands in the skin that secrete an oily/waxy matter, called sebum, to lubricate and waterproof the skin and hair of mammals...

s and less-viscous ones from modified apocrine sweat glands
Apocrine sweat glands
Apocrine sweat glands are sweat glands composed of a coiled secretory portion located at the junction of the dermis and subcutaneous fat, from which a straight portion inserts and secretes into the infundibular portion of the hair follicle...

. The primary components of earwax are shed layers of skin, with 60% of the earwax consisting of keratin
Keratin
Keratin refers to a family of fibrous structural proteins. Keratin is the key of structural material making up the outer layer of human skin. It is also the key structural component of hair and nails...

, 12–20% saturated and unsaturated long-chain fatty acids, alcohols, squalene
Squalene
Squalene is a natural organic compound originally obtained for commercial purposes primarily from shark liver oil, though plant sources are used as well, including amaranth seed, rice bran, wheat germ, and olives. All plants and animals produce squalene, including humans...

 and 6–9% cholesterol
Cholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...

.

Fear, stress and anxiety result in increased production of earwax from the ceruminous glands.

There are two distinct genetically
Genetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....

 determined types of earwax: the wet type, which is dominant, and the dry type, which is recessive. While Asians
Asian people
Asian people or Asiatic people is a term with multiple meanings that refers to people who descend from a portion of Asia's population.- Central Asia :...

 and Native Americans
Native Americans in the United States
Native Americans in the United States are the indigenous peoples in North America within the boundaries of the present-day continental United States, parts of Alaska, and the island state of Hawaii. They are composed of numerous, distinct tribes, states, and ethnic groups, many of which survive as...

 are more likely to have the dry type of cerumen (gray and flaky), black
Black people
The term black people is used in systems of racial classification for humans of a dark skinned phenotype, relative to other racial groups.Different societies apply different criteria regarding who is classified as "black", and often social variables such as class, socio-economic status also plays a...

 and white
White people
White people is a term which usually refers to human beings characterized, at least in part, by the light pigmentation of their skin...

 people are more likely to have the wet type (honey-brown to dark-brown and moist). Cerumen type has been used by anthropologists
Anthropology
Anthropology is the study of humanity. It has origins in the humanities, the natural sciences, and the social sciences. The term "anthropology" is from the Greek anthrōpos , "man", understood to mean mankind or humanity, and -logia , "discourse" or "study", and was first used in 1501 by German...

 to track human migratory patterns, such as those of the Inuit
Inuit
The Inuit are a group of culturally similar indigenous peoples inhabiting the Arctic regions of Canada , Denmark , Russia and the United States . Inuit means “the people” in the Inuktitut language...

. Wet-type of earwax is the more prevalent among Ainu
Ainu people
The , also called Aynu, Aino , and in historical texts Ezo , are indigenous people or groups in Japan and Russia. Historically they spoke the Ainu language and related varieties and lived in Hokkaidō, the Kuril Islands, and much of Sakhalin...

 of Japan, in contrast to Japanese people. The consistency of wet type earwax is due to the higher concentration of lipid
Lipid
Lipids constitute a broad group of naturally occurring molecules that include fats, waxes, sterols, fat-soluble vitamins , monoglycerides, diglycerides, triglycerides, phospholipids, and others...

 and pigment
Pigment
A pigment is a material that changes the color of reflected or transmitted light as the result of wavelength-selective absorption. This physical process differs from fluorescence, phosphorescence, and other forms of luminescence, in which a material emits light.Many materials selectively absorb...

 granules (50% lipid) in the substance than the dry type (30% lipid).

The difference in cerumen type has been tracked to a single base
Base pair
In molecular biology and genetics, the linking between two nitrogenous bases on opposite complementary DNA or certain types of RNA strands that are connected via hydrogen bonds is called a base pair...

 change (a single nucleotide polymorphism
Single nucleotide polymorphism
A single-nucleotide polymorphism is a DNA sequence variation occurring when a single nucleotide — A, T, C or G — in the genome differs between members of a biological species or paired chromosomes in an individual...

) in a gene known as "ATP-binding cassette
ATP-binding cassette transporter genes
ATP-binding cassette transporters are members of a protein superfamily that is one of the largest and most ancient families with representatives in all extant phyla from prokaryotes to humans...

 C11 gene." In addition to affecting cerumen type, this mutation also reduces sweat
Sweating
Perspiration is the production of a fluid consisting primarily of water as well as various dissolved solids , that is excreted by the sweat glands in the skin of mammals...

 production. The researchers conjecture that the reduction in sweat was beneficial to the ancestors of East Asians and Native Americans who are thought to have lived in cold climates.

Cleaning


Cleaning of the ear canal occurs as a result of the "conveyor belt" process of epithelial
Epithelium
Epithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the cavities and surfaces of structures throughout the body, and also form many glands. Functions of epithelial cells include secretion, selective...

 migration, aided by jaw
Jaw
The jaw is any opposable articulated structure at the entrance of the mouth, typically used for grasping and manipulating food. The term jaws is also broadly applied to the whole of the structures constituting the vault of the mouth and serving to open and close it and is part of the body plan of...

 movement. Cells formed in the centre of the tympanic membrane migrate outwards from the umbo
Umbo of tympanic membrane
The umbo is the most depressed part of the tympanic membrane.-Depression:The manubrium of the malleus is firmly attached to the medial surface of the membrane as far as its center, which it draws toward the tympanic cavity; the lateral surface of the membrane is thus concave, and the most depressed...

 (at a rate comparable to that of fingernail growth) to the walls of the ear canal, and move towards the entrance of the ear canal. The cerumen in the canal is also carried outwards, taking with it any dirt, dust, and particulate matter that may have gathered in the canal. Jaw movement assists this process by dislodging debris attached to the walls of the ear canal, increasing the likelihood of its expulsion.

Lubrication


Lubrication prevents desiccation
Desiccation
Desiccation is the state of extreme dryness, or the process of extreme drying. A desiccant is a hygroscopic substance that induces or sustains such a state in its local vicinity in a moderately sealed container.-Science:...

, itching, and burning of the skin
Skin
-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...

 within the ear canal (known as asteatosis). The lubricative properties arise from the high lipid
Lipid
Lipids constitute a broad group of naturally occurring molecules that include fats, waxes, sterols, fat-soluble vitamins , monoglycerides, diglycerides, triglycerides, phospholipids, and others...

 content of the sebum produced by the sebaceous glands. In wet-type cerumen at least, these lipids include cholesterol
Cholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...

, squalene
Squalene
Squalene is a natural organic compound originally obtained for commercial purposes primarily from shark liver oil, though plant sources are used as well, including amaranth seed, rice bran, wheat germ, and olives. All plants and animals produce squalene, including humans...

, and many long-chain fatty acid
Fatty acid
In chemistry, especially biochemistry, a fatty acid is a carboxylic acid with a long unbranched aliphatic tail , which is either saturated or unsaturated. Most naturally occurring fatty acids have a chain of an even number of carbon atoms, from 4 to 28. Fatty acids are usually derived from...

s and alcohol
Alcohol
In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....

s.

Antibacterial and antifungal effects


While studies conducted up until the 1960s found little evidence supporting antibacterial activity for cerumen, more recent studies have found that cerumen has a bactericidal effect on some strains of bacteria. Cerumen has been found to reduce the viability of a wide range of bacteria, including Haemophilus influenzae
Haemophilus influenzae
Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, Gram-negative, rod-shaped bacterium first described in 1892 by Richard Pfeiffer during an influenza pandemic. A member of the Pasteurellaceae family, it is generally aerobic, but can grow as a facultative anaerobe. H...

, Staphylococcus aureus
Staphylococcus aureus
Staphylococcus aureus is a facultative anaerobic Gram-positive coccal bacterium. It is frequently found as part of the normal skin flora on the skin and nasal passages. It is estimated that 20% of the human population are long-term carriers of S. aureus. S. aureus is the most common species of...

, and many variants of Escherichia coli
Escherichia coli
Escherichia coli is a Gram-negative, rod-shaped bacterium that is commonly found in the lower intestine of warm-blooded organisms . Most E. coli strains are harmless, but some serotypes can cause serious food poisoning in humans, and are occasionally responsible for product recalls...

, sometimes by as much as 99%. The growth of two fungi
Fungus
A fungus is a member of a large group of eukaryotic organisms that includes microorganisms such as yeasts and molds , as well as the more familiar mushrooms. These organisms are classified as a kingdom, Fungi, which is separate from plants, animals, and bacteria...

 commonly present in otomycosis
Otomycosis
Otomycosis is a fungal ear infection, a superficial mycotic infection of the outer ear canal. It is more common in the tropical countries. The infection may be either subacute or acute and is characterized by inflammation, pruritus, scaling, and severe discomfort...

 was also significantly inhibited by human cerumen. These antimicrobial properties are due principally to the presence of saturated
Saturation (chemistry)
In chemistry, saturation has six different meanings, all based on reaching a maximum capacity...

 fatty acids, lysozyme
Lysozyme
Lysozyme, also known as muramidase or N-acetylmuramide glycanhydrolase, are glycoside hydrolases, enzymes that damage bacterial cell walls by catalyzing hydrolysis of 1,4-beta-linkages between N-acetylmuramic acid and N-acetyl-D-glucosamine residues in a peptidoglycan and between...

 and, especially, to the slight acidity of cerumen (pH
PH
In chemistry, pH is a measure of the acidity or basicity of an aqueous solution. Pure water is said to be neutral, with a pH close to 7.0 at . Solutions with a pH less than 7 are said to be acidic and solutions with a pH greater than 7 are basic or alkaline...

 typically around 6.1 in normal individuals).

Treatment


Movement of the jaw helps the ears' natural cleaning process. The American Academy of Otolaryngology
American Academy of Otolaryngology
The American Academy of Otolaryngology - Head and Neck Surgery, originally started in the 1924, is the world's largest organization of over 13,000 specialist related to the area of ears, nose, and throat.- History :Reference...

 discourages earwax removal unless excess earwax is causing health problems. While a number of methods of earwax removal are effective, their benefits as compared to each other is not yet determined. A number of softeners are effective; however, if this is not sufficient, the most common method of cerumen removal is syringing
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...

 with warm water. A curette
Curette
A curette is a surgical instrument designed for scraping biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often similar in shape to a stylus; at the tip of the curette is a small scoop, hook, or gouge...

 method is more likely to be used by otolaryngologists
Otolaryngology
Otolaryngology or ENT is the branch of medicine and surgery that specializes in the diagnosis and treatment of ear, nose, throat, and head and neck disorders....

 when the ear canal is partially occluded and the material is not adhering to the skin of the ear canal. Cotton swab
Cotton swab
Cotton swabs or cotton buds or ear buds consist of a small wad of cotton wrapped around one or both ends of a short rod, usually made of either wood, rolled paper, or plastic...

s, on the other hand, push most of the earwax further into the ear canal and remove only a small portion of the top layer of wax that happens to adhere to the fibres of the swab.

Softeners


This process is referred to as cerumenolysis and is achieved using a solution known as a cerumenolytic agent, which is introduced into the ear canal. It usually makes the wax come out, and if it doesn't, it facilitates removal by syringing or curettage.

Commercially or commonly available cerumenolytics include:
  • Any of a number of types of oil
    Oil
    An oil is any substance that is liquid at ambient temperatures and does not mix with water but may mix with other oils and organic solvents. This general definition includes vegetable oils, volatile essential oils, petrochemical oils, and synthetic oils....

  • Carbamide peroxide
    Carbamide peroxide
    Carbamide peroxide, also called urea peroxide, urea hydrogen peroxide , and percarbamide, an adduct of hydrogen peroxide and urea. Like hydrogen peroxide, it is an oxidizer. This compound is a white crystalline solid which dissolves in water to give free hydrogen peroxide; the solubility of...

     (6.5%) and glycerine
  • A solution of sodium bicarbonate
    Sodium bicarbonate
    Sodium bicarbonate or sodium hydrogen carbonate is the chemical compound with the formula Na HCO3. Sodium bicarbonate is a white solid that is crystalline but often appears as a fine powder. It has a slightly salty, alkaline taste resembling that of washing soda . The natural mineral form is...

     in water, or sodium bicarbonate B.P.C. (sodium bicarbonate and glycerine)
  • Cerumol (arachis oil, turpentine
    Turpentine
    Turpentine is a fluid obtained by the distillation of resin obtained from trees, mainly pine trees. It is composed of terpenes, mainly the monoterpenes alpha-pinene and beta-pinene...

     and dichlorobenzene
    1,2-Dichlorobenzene
    1,2-Dichlorobenzene, or orthodichlorobenzene , is an organic compound with the formula C6H4Cl2. This colourless liquid is poorly soluble in water but miscible with most organic solvents...

    )
  • Cerumenex (Triethanolamine
    Triethanolamine
    Triethanolamine, often abbreviated as TEA, is an organic chemical compound which is both a tertiary amine and a triol. A triol is a molecule with three alcohol groups. Like other amines, triethanolamine is a strong base due to the lone pair of electrons on the nitrogen atom. Triethanolamine can...

    , polypeptides and oleate-condensate
    Oleic acid
    Oleic acid is a monounsaturated omega-9 fatty acid found in various animal and vegetable fats. It has the formula CH37CH=CH7COOH. It is an odorless, colourless oil, although commercial samples may be yellowish. The trans isomer of oleic acid is called elaidic acid...

    )
  • Exterol, Otex (UK brand name) (urea
    Urea
    Urea or carbamide is an organic compound with the chemical formula CO2. The molecule has two —NH2 groups joined by a carbonyl functional group....

    , hydrogen peroxide
    Hydrogen peroxide
    Hydrogen peroxide is the simplest peroxide and an oxidizer. Hydrogen peroxide is a clear liquid, slightly more viscous than water. In dilute solution, it appears colorless. With its oxidizing properties, hydrogen peroxide is often used as a bleach or cleaning agent...

     and glycerine)
  • Docusate, a detergent, an active ingredient
    Active ingredient
    An active ingredient is the substance of a pharmaceutical drug or a pharmaceutical ingredient and bulk active in medicine; in pesticide formulations active substance may be used. Some medications and pesticide products may contain more than one active ingredient...

     found in laxative
    Laxative
    Laxatives are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation. Certain stimulant, lubricant, and saline laxatives are used to evacuate the colon for rectal and/or bowel examinations, and may be supplemented by enemas under...

    s

A cerumenolytic should be used 2–3 times daily for 3–5 days prior to the cerumen extraction.

A review of studies found that topical preparations for the treatment of earwax were better than no treatment and that there was little difference between oil based and water based preparations (including plain water).

Syringing


Once the cerumen has been softened, it may be removed from the ear canal by irrigation. This may be effectively accomplished with a bulb syringe
Syringe
A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube , allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube...

 at home. Ear syringing techniques are described in great detail by Wilson & Roeser, and Blake et al., who advise pulling the external ear up and back, and aiming the nozzle of the syringe slightly upwards and backwards so that the water flows as a cascade along the roof of the canal. The irrigation solution flows out of the canal along its floor, taking wax and debris with it. The solution used to irrigate the ear canal is usually warm water, normal saline
Saline (medicine)
In medicine, saline is a general term referring to a sterile solution of sodium chloride in water but is only sterile when it is to be placed intravenously, otherwise, a saline solution is a salt water solution...

, sodium bicarbonate solution, or a solution of water and vinegar
Vinegar
Vinegar is a liquid substance consisting mainly of acetic acid and water, the acetic acid being produced through the fermentation of ethanol by acetic acid bacteria. Commercial vinegar is produced either by fast or slow fermentation processes. Slow methods generally are used with traditional...

 to help prevent secondary infection.

Patients generally prefer the irrigation solution to be warmed to body temperature, as dizziness
Dizziness
Dizziness refers to an impairment in spatial perception and stability. The term is somewhat imprecise. It can be used to mean vertigo, presyncope, disequilibrium, or a non-specific feeling such as giddiness or foolishness....

 is a common side effect of syringing with fluids that are colder or warmer than body temperature. Sharp et al. recommend 37 °C, while Blake et al. recommend using water at 38 °C, one degree above body temperature, and stress that this should be checked with a thermometer. Any other temperature may cause vertigo
Vertigo (medical)
Vertigo is a type of dizziness, where there is a feeling of motion when one is stationary. The symptoms are due to a dysfunction of the vestibular system in the inner ear...

, just as used when testing the caloric reflex test
Caloric reflex test
In medicine, the caloric reflex test is a test of the vestibulo-ocular reflex that involves irrigating cold or warm water or air into the external auditory canal.-Utility:...

.

A syringe should be used to gently stream water into the ear. For children the rate and speed should be lower. After irrigating, the head is tipped to allow the water to drain. Irrigation may need to be repeated several times. If the water stream hurts, then the flow should be slower. It is better to irrigate too gently for a long period than irrigate too forcefully attempting to remove wax quickly. This procedure can be done at home in the shower using an ear irrigation syringe with a right angle tip. After the wax is removed, the ear can be dried by tipping the head and gently pulling the ear upwards to straighten the ear canal.

Curette and cotton swabs


Earwax can be removed with an ear pick
Ear pick
Ear picks, also called ear scoops, or ear spoons, are a type of curette used to clean the ear canal of earwax . These are traditionally made from bamboo or precious metals such as silver or gold, but more commonly from stainless steel or plastic.Use of an ear pick is hazardous and may be...

/curette, which physically dislodges the earwax and scoops it out of the ear canal. In the west, use of ear picks is usually only done by health professionals; a modified curette having a safety stop to prevent deep insertion for self-use is available. Curetting earwax using an ear pick is common in East Asia
East Asia
East Asia or Eastern Asia is a subregion of Asia that can be defined in either geographical or cultural terms...

. As the earwax of most East Asians is of the dry type, it is extremely easily removed by light scraping with an ear pick, as it simply falls out in large pieces or dry flakes, often on its own.

It is generally advised not to use cotton swab
Cotton swab
Cotton swabs or cotton buds or ear buds consist of a small wad of cotton wrapped around one or both ends of a short rod, usually made of either wood, rolled paper, or plastic...

s (Q-Tips or cotton buds), as doing so will likely push the wax farther down the ear canal, and if used carelessly, perforate the eardrum
Eardrum
The eardrum, or tympanic membrane, is a thin membrane that separates the external ear from the middle ear in humans and other tetrapods. Its function is to transmit sound from the air to the ossicles inside the middle ear. The malleus bone bridges the gap between the eardrum and the other ossicles...

. Abrasion of the ear canal, particularly after water has entered from swimming or bathing, can lead to ear infection. Also, the cotton head may fall off and become lodged in the ear canal. Cotton swabs should be used only to clean the external ear.

Vacuuming


Vacuuming of the ear may be done by professionals or by home-vacuum kits. However, home "ear vacs" were ineffective at removing ear-wax, especially when compared to a Jobson-Horne probe.

Complications of removal


A postal survey of British general practitioners found that only 19% always performed cerumen removal themselves; many delegated the task to practice nurses, some of whom had received no instruction. It is problematic as the removal of cerumen is not without risk. Irrigation can be performed at home with proper equipment as long as the person is careful not to irrigate too hard. All other methods should only be carried out by individuals who have been sufficiently trained in the procedure.

The author Bull advised physicians: "After removal of wax, inspect thoroughly to make sure none remains. This advice might seem superfluous, but is frequently ignored." This was confirmed by Sharp et al., who, in a survey of 320 general practitioners, found that only 68% of doctors inspected the ear canal after syringing to check that the wax was removed. As a result, failure to remove the wax from the canal made up approximately 30% of the complications associated with the procedure. Other complications included otitis externa
Otitis externa
Otitis externa is an inflammation of the outer ear and ear canal. Along with otitis media, external otitis is one of the two human conditions commonly called "earache". It also occurs in many other species. Inflammation of the skin of the ear canal is the essence of this disorder...

, pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

, vertigo
Vertigo (medical)
Vertigo is a type of dizziness, where there is a feeling of motion when one is stationary. The symptoms are due to a dysfunction of the vestibular system in the inner ear...

, tinnitus
Tinnitus
Tinnitus |ringing]]") is the perception of sound within the human ear in the absence of corresponding external sound.Tinnitus is not a disease, but a symptom that can result from a wide range of underlying causes: abnormally loud sounds in the ear canal for even the briefest period , ear...

, and perforation of the ear drum. Based on this study, a rate of major complications in 1/1000 ears syringed was suggested.

Claims arising from ear syringing mishaps account for about 25% of the total claims received by New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...

's Accident Compensation Corporation
Accident Compensation Corporation
The Accident Compensation Corporation is a New Zealand Crown entity responsible for administering the Accident Compensation Act 2001. The Act provides support to citizens, residents, and temporary visitors who have suffered personal injuries....

 ENT Medical Misadventure Committee. While high, this is not surprising, as ear syringing is an extremely common procedure. Grossan suggested that approximately 150,000 ears are irrigated each week in the United States, and about 40,000 per week in the United Kingdom. Extrapolating from data obtained in Edinburgh, Sharp et al. place this figure much higher, estimating that approximately 7000 ears are syringed per 100,000 population per annum. In the New Zealand claims mentioned above, perforation of the tympanic membrane was by far the most common injury resulting in significant disability.

Alternative medicine


Ear candling
Ear candling
Ear candling, also called ear coning or thermal-auricular therapy, is an alternative medicine practice claimed to improve general health and well-being by lighting one end of a hollow candle and placing the other end in the ear canal. According to medical researchers, it is both dangerous and...

, also called ear coning or thermal-auricular therapy, is an alternative medicine
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....

 practice claimed to improve general health and well-being by lighting one end of a hollow candle
Candle
A candle is a solid block or cylinder of wax with an embedded wick, which is lit to provide light, and sometimes heat.Today, most candles are made from paraffin. Candles can also be made from beeswax, soy, other plant waxes, and tallow...

 and placing the other end in the ear canal
Ear canal
The ear canal , is a tube running from the outer ear to the middle ear. The human ear canal extends from the pinna to the eardrum and is about 35 mm in length and 5 to 10 mm in diameter....

. According to medical researchers, it is both dangerous and ineffective. Advocates say that the dark residue that shows after the procedure is extracted earwax, proving the efficacy of the procedure. Studies have shown that in fact the same residue is left whether or not the candle (which is made of cotton fabric and beeswax and leaves a residue after burning) is inserted into an ear.

History


The treatment of ear wax was described by Aulus Cornelius Celsus
Aulus Cornelius Celsus
Aulus Cornelius Celsus was a Roman encyclopedist, known for his extant medical work, De Medicina, which is believed to be the only surviving section of a much larger encyclopedia. The De Medicina is a primary source on diet, pharmacy, surgery and related fields, and it is one of the best sources...

 in De Medicina
De Medicina
De Medicina is a 1st-century medical treatise by Aulus Cornelius Celsus, a Roman encyclopedist and possibly a practicing physician. It is the only surviving section of a much larger encyclopedia; only small parts still survive from sections on agriculture, military science, oratory, jurisprudence...

in the first century:

Uses for earwax

  • In medieval times earwax, and other substances such as urine
    Urine
    Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...

    , were used to prepare pigment
    Pigment
    A pigment is a material that changes the color of reflected or transmitted light as the result of wavelength-selective absorption. This physical process differs from fluorescence, phosphorescence, and other forms of luminescence, in which a material emits light.Many materials selectively absorb...

    s used by scribe
    Scribe
    A scribe is a person who writes books or documents by hand as a profession and helps the city keep track of its records. The profession, previously found in all literate cultures in some form, lost most of its importance and status with the advent of printing...

    s to illustrate illuminated manuscript
    Illuminated manuscript
    An illuminated manuscript is a manuscript in which the text is supplemented by the addition of decoration, such as decorated initials, borders and miniature illustrations...

    s.
  • The 1832 edition of the American Frugal Housewife said that "nothing was better than earwax to prevent the painful effects resulting from a wound by a nail [or] skewer"; and also recommended earwax as a remedy for cracked lips
    Lip balm
    Lip balm or lip salve is a wax-like substance applied topically to the lips of the mouth to relieve chapped or dry lips, angular cheilitis, stomatitis, or cold sores. Lip balm often contains beeswax or carnauba wax, camphor, cetyl alcohol, lanolin, paraffin, and petrolatum, among other ingredients...

    .
  • Before waxed thread was commonly available seamstresses would use their own earwax to stop the cut ends of threads from fraying.

In other animals

  • Many types of whale
    Whale
    Whale is the common name for various marine mammals of the order Cetacea. The term whale sometimes refers to all cetaceans, but more often it excludes dolphins and porpoises, which belong to suborder Odontoceti . This suborder also includes the sperm whale, killer whale, pilot whale, and beluga...

    s have a build-up of earwax which increases with time; the size of the deposit is sometimes the only way to determine the age of whales that do not have teeth.

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