Surprisingly True Facts about Earwax
Earwax is one of those body fluids that evokes polarizing reactions that can range from fascination to disgust. Hidden inside one of our body’s few cul de sacs, it is rarely discussed in polite society. Most of the time, we don't think about it, except when we are being naughty and dig into our ears with cotton swabs. Or after we accidentally push it farther in, and it blocks our hearing.
Although we judge earwax harshly, we are actually lucky to have it. Along with its role in protecting our ears, wax has had a surprising variety of other uses over the years. And just like its smell, we may find these uses surprising and sometimes vile.
Earwax wasn’t always a dirty little secret.
In her 1828, book, The American Frugal Housewife, Lydia Maria Child, was the first to suggest using earwax as a balm for dry lips. In a later edition, she had another application: as a salve for puncture wounds. It probably wasn’t much help against tetanus, but I bet it came in handy during the war.
Before sewing machines, seamstresses would use a dab of ear wax on the end of their thread to keep it from fraying; something to consider the next time you snuggle under your grandmother’s heirloom quilt.
More recently, there has been research on the medical uses of earwax. Some have called it a “neglected biological matrix” because it is so easily sampled and readily available. Earwax provides information about ethnicity, gender, diet, and exposure to pollutants. One group of researchers used it to diagnose diabetes mellitus. The same group has studied the use of earwax in diagnosing drug abuse, intoxication, and even cancer. But, for some reason, sampling it hasn't caught on.
Although we call it wax, it isn’t wax at all.
The German word for earwax is more appropriately called ohrenschmalz, or ear fat. That’s right. Earwax is made primarily of fatty acids and cholesterol from sebaceous glands mixed with sweat and a lot of dead skin cells. It also contains antimicrobial peptides, which make it harder for bacteria and fungus to grow. (The salve idea wasn’t that far off after all.)
Found only in humans and mammals, only made in the outer third of the canal–the part made of cartilage. It's function is to seal and moisturize the ear canal skin, which otherwise gets dry because. Because ear canals are anatomic dead ends that curve and angle downwards, it's easy for dead skin, dirt, and who knows what else to get stuck inside. Lucky for us, earwax traps this detritus at the entrance. Then, with the help of jaw movement (i.e chewing) and the skin of the ear canal slowly growing from the inside out like a conveyor belt, the sticky amalgamation gets pushed out of the ear. Except when it doesn't. Or when we stick something inside and push it back in.
Research tells us that earwax comes in two varieties: dry and wet. A single gene determines which kind you have, with wet being dominant and dry being recessive. (Interestingly, wet earwax is also associated with more body odor.) As an Ear, Nose, and Throat doctor, I can personally attest to encountering far more varieties in my patients. Some wax is amorphous and sticky. Other wax has the consistency and smell of peanut butter. I’ve pulled out long “ribbons” of wax that look like paper. And not all wax is yellow or honey-colored. I’ve seen wax in every shade from white to brown, including near black. Wax gets darker and harder the longer it sits in your ear. Sometimes, if it’s been stuck inside for a long time, it comes out covered in a layer of skin or embedded with hairs.
We need just the right amount of earwax, in just the right consistency, to keep our ears healthy.
Too little wax can lead to outer ear infections. This happens because the ear canal skin can crack and bacteria and fungus can get in. Commonly called swimmer’s ear, an external ear infection can also happen from showering, getting your hair done, or anything else that creates moisture. The most common cause of deficient earwax is overusing cotton swabs. Scratching that itch may feel orgasmic, but if you wipe away all the wax, you could be setting yourself up for pain and even more itching.
Speaking of itching, ear canals that are too dry and lack wax can grow fungus–something I call athletes' foot of the ear. The key to treating it is keeping the ear dry and sealed with earwax or coconut oil.
Some people inherently over-produce earwax, but no one knows why. There are environmental factors that can increase its production, like allergies, exposure to pollutants, or putting things in your ears (i.e. headphones or hearing aids). Certain foods are thought to increase production, like gluten, dairy, caffeine, and sugar. As we get older, our ear canals change shape and grow more hair, which can trap wax. Loud noise, on the other hand, does not impact production.
If wax gets stuck in your ear, it can block your hearing. Ironically, this is the moment many people reach for a cotton swab. But that’s the worst way to treat it. Once your ear is full of wax, a cotton swab only pushes it in further. Some people try ear drops to soften the wax or the controversial ear candling. Some cultures employ tiny spoons or picks. There are also countless devices on the market that promise to help you safely clean out your ears. But they rarely work. Many people just live with the blockage or may not even know they have it. Others have regular visits to the doctor to have it removed.
In the U.S., wax impaction leads to 12 million patient visits a year.
Doctors remove wax in three main ways: by flushing it out with water, suctioning it out with a micro-suction, or pulling it out with various tools.
I have to admit, as gross as it sounds, removing wax is my favorite part of being an ENT. Nothing beats the catharsis of pulling out a huge glob.
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