Earwax: Should It Be Removed?

W. Steven Pray, PhD, DPh; Joshua J. Pray, PharmD

Disclosures

US Pharmacist. 2005;30(5) 

In This Article

Cerumen

The removal of cerumen can be dangerous, particularly if unsafe methods are used.

Earwax is an important defense against infection. Nevertheless, it is thought by most people to be a cosmetic nuisance that denotes uncleanliness. Its continuous removal compromises the integrity of the ear's defenses against infection and can contribute to cerumen impaction, a leading cause of impaired hearing.

Production

The otic canal contains a variety of specialized structures that act in concert to produce cerumen. Foremost is the ceruminous gland—a set of 1,000 to 2,000 coiled, tubular apocrine sweat glands structurally similar to apocrine sweat glands in the axillae.[1—3] These glands produce peptides, whereas sebaceous glands opening into hair follicles in the canal secrete saturated and unsaturated long-chain fatty acids, alcohols, squalene, and cholesterol.[2]

Composition

The epidermal cells lining the external ear are virtually identical to those on the skin surface. Thus, they go through a predictable process of generation, upward migration, and eventual sloughing. When this occurs on the outer skin, the cells simply fall away. However, in the ear, there is less opportunity for them to be shed insensibly. Rather, these desquamated cells tend to collect in the ear canal in sheets, becoming 60% by weight of total cerumen.[2] Cerumen also contains lysozyme, an antibacterial enzyme capable of destroying bacterial cell walls.[1] Genetics confers a significant difference in the type of cerumen.[2] Caucasians and African-Americans have cerumen that is described as light to dark brown, sticky, and moist. Asians' and Native Americans' cerumen is gray or tan, brittle, and dry due to lower amounts of lipid and pigment granules.

Physiological Usefulness

Cerumen has many helpful properties for the ear. It provides the external auditory canal with a protective barrier that coats and lubricates the canal.[3] Its sticky nature traps foreign objects, preventing direct contact with various organisms, pollutants, and insects. Cerumen also has an acidic pH (about 4 to 5). This pH is unfavorable for organisms, which may help reduce the risk of infection of the external auditory canal.[1]

Cerumen can help lower the risk of diffuse acute external otitis. In this condition, the patient suffers a break in the epidermis of the external otic canal, often through improper ear cleaning methods, such as the use of toothpicks, keys, pencils, and so on. If there is no protective cerumen to coat and seal the epidermal tear, organisms may infect the area. The most common are Pseudomonas aeruginosa and staphylococci.[1] If the humidity and temperature are conducive to growth, the patient will develop diffuse acute external otitis, also known as swimmer's ear.

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