Recently a patient came in with his wife for a routine hearing aid and ear cleaning appointment. After looking into his ear canal, I asked him when he last used a Q-tip to clean his ear. He said he had used one that morning. His wife asked how I knew he had used a Q-tip, and so I showed her some of the signs that indicated he had used a cotton swab to clean his ear.

Using my video otoscope, I was able to show them on the monitor what I was seeing. I pointed out the two most obvious signs. The first was a hematoma (bruise) next to the eardrum. The second was significant wax impacted near the eardrum, while there was nothing in the outer portion of the canal where earwax is produced. They were both surprised by the location of the bruise and that he had actually pushed the Q-tip so close to the eardrum (within a few millimeters.)

Earwax is completely normal and natural and not necessarily a sign of poor hygiene. If everything is working normally, the ear will produce two excretions that make up earwax. The first is sebaceous, an oil that is secreted from glands that are found in the ear, as well as throughout the body. The second is cerumen, which is excreted from glands found only in the ear, typically in the outer portion of the ear canal. These excretions, along with fine hairs, protect the ear canal from foreign materials such as dirt, dust or bugs. As new skin cells grow, dead skin sloughs off and combines with the wax. The skin in the ear canal grows outward away from the eardrum and carries wax to the opening of the canal. (Some individuals have a condition where the skin grows the opposite direction, which causes the wax and dead skin to build up on the eardrum.) As the combination of substances migrates to the canal opening and into the concha, or bowl of the ear, it can then be wiped or washed out. It is not unusual to have to clean wax from the concha on a daily basis.

In some cases, the wax does not work its way out of the canal as it should. This may happen because the ear canal is too narrow, wax production is excessive, the earwax is exceptionally sticky, or the wax is pushed back into the canal by foreign objects such as a Q-tip. In addition, protective earplugs, earphones or even hearing aids can prevent the wax from migrating outward, or push it back into the canal.

When wax does not work itself out of the canal as it should, it can block the ear canal. This blockage will cause some level of hearing loss, ranging from mild to total conductive hearing loss depending on the amount, composition and location of the wax. Water can become trapped around and behind the earwax, which can lead to an external ear infection from bacteria or fungus.

Though over the counter products exist for wax removal, we recommend never putting anything into the canal until the condition and contents of the canal can be verified.If you experience sudden hearing loss, have your ears checked immediately. Sudden onset hearing loss from earwax impaction is reversible, while sudden onset loss from other causes is often permanent if not reversed with immediate medical care.