The Surprising Science of Earwax (And Why Cotton Swabs Are a Bad Idea)

Most of us think of earwax as something to get rid of. In fact, it's one of the body's cleverer inventions. And the cotton swab, the tool so many of us use every day, is the one doctors most often tell us to keep out of our ears.

What earwax actually is

Earwax, known medically as cerumen, is made in the outer part of the ear canal. It's a mix of oils and secretions from glands in the skin, combined with dead skin cells and anything it has caught on the way.

It has several jobs:

• It cleans the ear canal, carrying dirt and dead skin out of the ear.
• It moisturizes the ear canal, so the skin doesn't get dry and itchy.
• It helps protect against infection. Earwax has antibacterial properties that make life harder for germs.

Your ears clean themselves

Here's the clever part. Old wax and dead skin cells slowly travel outward, from the eardrum to the opening of the ear, a bit like a conveyor belt, helped along by jaw movements when you talk and chew. At the outer ear, the wax dries and falls out, often without you noticing.

For most people, that means the inside of the ear canal needs no cleaning at all.

Why there are two types of earwax

Earwax comes in two main types: wet (sticky and yellow-brown) and dry (flaky and pale). Which one you have comes down to a tiny difference in one gene, called ABCC11. Dry earwax is common in people of East Asian ancestry, while wet earwax is the usual type in most other populations. Neither type is healthier.

Why cotton swabs are a bad idea

Ear, nose and throat specialists advise against putting cotton swabs, or anything else, inside the ear canal. Here's why:

• They push wax deeper. Instead of removing wax, a swab often packs it further into the canal, where the conveyor belt can't move it out. This can lead to a blockage, muffled hearing or a feeling of fullness.
• They can injure the ear. A swab pushed too far can scratch the canal or, in rare cases, damage the eardrum.
• They remove the protective layer. Cleaning too much can leave the ear canal dry and itchy, which tempts you to clean even more.

Ear candles are another popular idea that doesn't work: there's no evidence they remove wax, and they can damage the ear canal and eardrum.

How to look after your ears

• Leave the inside alone. Wash the outer ear with a washcloth, and let the canal take care of itself.
• Soften stubborn wax. If wax builds up, a few drops of over-the-counter ear drops, mineral oil or baby oil can soften it so it works its way out naturally. If you might have a hole in your eardrum, check with a doctor before using any drops.
• Let a professional remove a blockage. A doctor or nurse can safely remove wax that's causing problems.

When to see a doctor

Get help if you have ear pain, discharge, bleeding, sudden hearing loss, ringing in the ears or dizziness, or if a blocked feeling doesn't clear after a few days of softening drops. People who wear hearing aids are more likely to build up wax and can benefit from a check every 6 to 12 months.

For everyone else, the best ear-cleaning routine is the simplest one: let your ears do their job.

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Sources

1. American Academy of Otolaryngology-Head and Neck Surgery. Earwax and cerumen impaction. ENT Health.
2. American Family Physician. Summary of the AAO-HNS clinical practice guideline on earwax. 2017.
3. The Hearing Review. Report on the AAO-HNS earwax guideline update. 2017.
4. Yoshiura K, et al. A SNP in the ABCC11 gene is the determinant of human earwax type. Nature Genetics. 2006;38(3):324-330.