The external ear canal is a tubular structure that leads from the external meatus to the eardrum at its end. The outer 1/3 of the canal is the cartilagenous canal and the inner 2/3 of the canal is the bony canal. The ear canal and eardrum are lined with skin, but what is unique about ear canal skin is that the surface cells migrate from center of the eardrum towards the outside. It actually takes a few months for skin cells to migrate all the way from the center of the eardrum out to the lateral opening of the ear canal.
Along the way, the skin cells which slough mix with cerumen formed by the ceruminous glands found at the bottom of the hair follicles in the outer 1/3 of the ear canal. This forms what is known as earwax. The earwax mostly will fall out from the ear canal on a fairly regular basis in the large majority of individuals without need for manipulation or cleaning.
It is very important that the ear canal stays dry overall. Because it is a blind pouch, if it was wet and stayed wet, it would be much more likely to become infected with overgrowth of bacteria or fungus, causing a condition called otitis externa. Earwax is very important in the protection of the ear canal. It helps to repel water and itself has antibacterial and antifungal properties.
However, the earwax needs to be in the outer 1/3 of the ear canal for it to function optimally. If it is too often cleaned out (with q-tips, frequent application of wax-softening drops, etc), or if it is pushed into the medial ear canal with q-tips or other ear-cleaning instruments, it is not as effective at preventing water entry and puts the ear canal at higher risk of infection.
Therefore, I often tell my patients to avoid all self-cleaning or manipulation of the ears. If patients tend to build up wax, as long as it is not causing problems with hearing, it is ok to leave it there. There is also a small risk of damage to the eardrum and loss of hearing if the q-tip or other instrument is stuck too far into the ear – which can happen in a variety of ways. If q-tips are used too often in certain patients with a tendency to have chronically inflamed or allergic ear canal skin, over years, some patients can develop scarring of the ear canal skin which can extend onto the eardrum, causing hearing losss.
Keeping your ears clear of excess wax?
If you really want to try to help wax come out of the ear, you can do a few things to help:
First of all, it is helpful to not wear insert earphones too often when listening to music or podcasts, etc, as frequent use of these can prevent wax from migrating out of the ear canal. If you wear hearing aids, it may contribute to your needing to come into the ENT doctor to get your wax cleaned on a regular basis (every 6-12 months possibly).
If you tend to have hard wax, you can use some over-the-counter wax softening drops on a limited basis, at most 1 time a week for several weeks. You can also use a drop of baby oil or mineral oil up to once a week to keep the wax lubricated so that it comes out more easily. Do not use these substances if you have a hole in the eardrum.
How to keep the ears dry
Most patients don’t have to worry about water entering the ears when showering, but patients who have too little wax in the outer 1/3 of their ear canals may need to try to keep water out of the ear when showering. I always strongly discourage anybody from purposely rinsing the ear canals with water on any regular basis more than once every 3-6 months.
I often also have patients keep water out of the ear in the weeks to months after ear surgery as well as in the case of otitis externa (external ear infection). In these cases, often we are having patients use medicated prescription eardrops. But besides the drops, it is important to keep water out.
To keep water out of the ear when showering, I encourage my patients to place a cotton ball in the outer hollow of the ear and then smear vaseline all over the outside of it so that the ear canal is sealed while showering.
In patients who have external ear infections who typically wear hearing aids, I also have them keep the hearing aids out of the affected ear as much as possible. I also discourage any of my patients who have infections to use earphones (insert or otherwise) on more than a limited basis, because it is important to allow the moisture in the ear canal to evaporate.
There are some patients who must swim, but have a problem with moisture in the ear canal or another problem that can lead to external ear infections. In those circumstances, I strongly encourage well-fitting waterproof earplugs, and an “ear band” or a swim cap that pulls far down over the ears (there is one with a cutout for the ear), in order to keep the earplugs in place.
Occasionally, patients can also help to dry out their ears with the application of acetic acid drops or gentle flushes with rubbing alcohol/white vinegar, but I feel it is important to not do this on your own without your ear doctor’s permission first.
Brian Kung, MD 