One of the most common questions I get asked is, "why do my ears keep blocking up with wax?". Many people assume they're producing too much ear wax, but that is often not the case. This article will discuss the most common reasons for ear wax buildup.

Ear Wax is Normal

First of all, ear wax production is completely normal. It's healthy, it lubricates the ear canals, and it protects your ears by trapping dirt, dust, bacteria, bugs and other foreign objects. If you haven't read it yet, I would encourage you to read my other article following this one: "Ear Wax Microsuction vs Ear Syringing" which dives into more detail about ear wax.

It's Often a Wax Migration Problem - Not a Wax Production Problem

This may come as a surprise to you, but the ear is actually self-cleaning. The skin of the ear canal is like a very, very slow conveyor belt - it grows outward and takes all of the wax and debris with it. So, ear wax would normally migrate out of the ear - but blockages can occur when this migration is interrupted.

Common Reasons Wax Keeps Building Up

Think of anything that might go against or interrupt this natural migration or 'self-cleaning' system.

Hearing Aids

Hearing aids are pushed into the ear where they sit for most of the day (all waking hours are recommended). By 1) pushing into the ear, and 2) staying there most of the day thus blocking the ear canal - you can probably imagine how this interrupts wax migration. However, hearing aids play an important role for people with hearing loss with respect to their hearing ability, psychological and social wellbeing, and cognitive wellbeing - among other positive factors. So for those who have wax build-up attributed to their hearing aids, the advice is to schedule in regular ear health checks/wax removal and not to stop using their hearing aids.

Earbuds and Headphones

This can impact wax buildup in a similar way to hearing aids. The main difference being that these are not essential for use in the way that hearing aids are.

Cotton Tips

Think cotton tips are helping to remove ear wax? Think again! Consider the thickness of a cotton tip and the available space in the ear canal. When you push in a cotton tip you may see some soft wax come out (by touching the wax), however, you are pushing the majority of it deeper in the canal thereby causing the ear wax impaction. Moreover, when you push wax into this deeper 'bony part' of the ear canal (the deeper two thirds of the ear canal), there is almost no chance the ear will be able to naturally push this out. It sits, impacted, becoming hard, dark, and stuck to the skin. Importantly, pushing something like a cotton tip in the ear can also risk perforation of the ear drum or damage to the ear canal walls. We can spot a bruised ear canal instantly! Many people believe their ear drums are very deep - but in fact, they are on average only about 25mm deep.

Naturally Narrow Ear Canals

For those with naturally narrow ear canals, you may find wax impaction also occurs often for you too. Try and imagine a skinny tube with sticky wax secreting inside - the skinnier the tube is, will make it much harder for the wax to be pushed through. So in these cases where the wax can't be naturally pushed through, it can get stuck, harden, and build-up over time.

Hairy Ear Canals

Hair in the canals serves a similar purpose to ear wax in that it traps dirt and dust, however, it can also trap the wax. This can slow down the natural migration of wax, but thick hair can also capture hard clumps that get stuck.

Skin Conditions

More than half of the ear wax's make-up is from the collection of dead skin cells. It's capturing them to clean them out of your ears - pretty great, right? However, what about skin conditions such as eczema or psoriasis that causes excess skin shedding? Again, this can prove to lead to a dry ear wax blockage. Sometimes, certain moisturisers may help with this to an extent. Make sure to always speak with your GP or pharmacist before starting any treatment.

Age

As we get older, our ears naturally make less moisture so ear wax gets dry and hard. Dryer ear wax moves out of the ear very slowly and so its very easy to get trapped and build-up into a blockage.

Can You Prevent Wax Build-Up?

Sometimes, yes. Avoid using cotton tips completely, use hearing aids correctly, use appropriate wax softeners for maintenance where recommended, and schedule routine reviews for people who are prone to impaction - as described above. For those who are prone, removing small amounts (or 'partial' blockages) is far more comfortable than leaving it until your ears are completely blocked with layers of impacted hard wax.

Should You Clean Your Own Ears?

We discussed the dangers of cotton tips above. This is certainly not recommended. Many people also query the use of ear candles. Not only do ear candles not work, but they also pose a risk of damaging the ear canal and ear drum with the heat imposed to the ear. Ear cameras and DIY tools are becoming more and more widely available over the past few years. Again, I would have to strongly advise against these for a few good reasons, untrained users can easily; 1) scratch the sensitive and fragile ear canal creating painful micro-tears, 2) perforate the very thin (0.1mm thick) ear drum with one small slip or wrong angle, 3) push ear wax deeper into the ear (happens way more often than you might imagine), and 4) the use of unsterilised tools can introduce new germs and lead to infection. It's also important to consider that the cameras are generally not very good - not necessarily the clarity, but the depth perception can be very misleading, increasing the chance of accidental injury.

As the age-old recommendation goes, don't put anything smaller than your elbow into your ear!

When Should You See An Audiologist?

• Sudden drop in hearing (see an audiologist urgently - same day. It may not be wax)

• Hearing aid whistling

• Blocked sensation

• Ear pain/itchiness

• Tinnitus

Take Home Message

Most people who experience recurring ear wax build-up aren't producing too much ear wax - they're experiencing problems with the ear's natural self-cleaning process. Understanding why it happens is the first step towards managing it effectively.

Written by Daniel Gerace, Clinical Audiologist and Owner of Solo Audiology and Hearing.