What is ear wax and why do we have it?

Earwax is produced by sebaceous and cerumenous glands in the ear canal, which leads from the outer ear to the eardrum. Earwax helps protect the ear by trapping dust and other foreign particles that could filter through and damage the eardrum. Normally, earwax moves toward the opening of the ear and falls out or is washed away, but some people’s ears produce too much wax. This is referred to as Excessive Earwax or Impacted Cerumen.

Excessive earwax is a major concern. As it may impede the passage of sound in the ear canal, causing mild conductive hearing loss, pain in the ear, itchiness, or dizziness. Untreated impacted wax can result in hearing loss, social withdrawal, poor work function and even mild paranoia. Some people with impacted wax present with perforated eardrums, the reason for this is usually self-induced as compacted earwax alone cannot perforate eardrum, for example due to the use of earbuds.Physical exam usually checks for visibility of the tympanic membrane which can be blocked by excessive cerumen.

Impacted cerumen may improve on its own, but treatment by a doctor is generally safe and effective. Hearing usually returns completely after the impacted earwax is removed. Trying to remove impacted cerumen at home with a cotton swab or by ear candling is not recommended, as this may push the cerumen even further into the ear canal causing even more blockage.

Hearing aids may be associated with increased earwax impaction,as they prevent earwax from being removed from the ear canal, thus causing blockage which leads to it being impacted. It is estimated to be the cause of 60–80% of hearing aid faults. Earwax can get into a hearing aid’s vents and receivers, and degrades the components inside the hearing aid due to its acidity. Excessive earwax can also cause tinnitus, a constant ringing in the ears, ear fullness, hearing loss and ear pain.

The wet type earwax differs biochemically from the dry type mainly by its higher concentration of lipid and pigment granules; for example the wet type is 50% lipid while the dry type is only 20%.

A specific gene has been identified that determines whether people have wet or dry earwax. The difference in cerumen type has been tracked to a single base change (a single nucleotide polymorphism) in a gene known as “ATP-binding cassette C11 gene“, specifically rs17822931. Dry-type individuals are homozygous for adenine whereas wet-type requires at least one guanine. Wet-type earwax is associated with armpit odor, which is increased by sweat production. Researchers have conjectured that the reduction in sweat or body odor was beneficial to the ancestors of East Asians and Native Americans who are thought to have lived in cold climates.

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