Ear wax (cerumen) and Dry Ears

What Is Ear Wax and Its Physiological Role?

Ear wax, also called cerumen, is a natural substance produced by glands in the outer part of the ear canal. It is made up of a mix of secretions from ceruminous glands (producing cerumen) and sebaceous glands (producing sebum, an natural oil and protector), as well as dead skin cells (called keratin). Contrary to what many people believe, ear wax is not a sign of poor hygiene—it actually plays a crucial role in keeping your ears healthy!

Functions of ear wax:

• Protection: It traps dust, dirt, and microorganisms, preventing them from reaching the eardrum.

• Lubrication: It prevents the skin inside the ear from becoming dry and itchy.

• Cleaning: As it moves out of the ear canal naturally, it helps remove debris.

Anatomy of the Ear Canal: Cartilaginous vs. Bony Sections

The ear canal is about 2.5 cm long and consists of two parts:

• Cartilaginous (outer one-third): This portion contains the glands that produce cerumen. It has a thicker lining and hair follicles, which help in the movement of ear wax toward the outer ear.

• Bony (inner two-thirds): This section is closer to the eardrum. It does not have glands or hair and is more sensitive. That's why inserting objects deep into the canal can be painful and potentially damaging.

Understanding this anatomy helps explain why most ear wax is formed near the entrance of the ear and why self-cleaning with cotton swabs can push wax deeper toward the eardrum, leading to blockage. That's how I can tell if a patient has been using Q-tips: I'll find wax deep down in the ear canal where it does not belong!

Causes of Excessive Wax Buildup

While most people’s ears clean themselves naturally, some factors can lead to excess wax:

• Frequent use of earbuds or hearing aids: These can block the natural migration of wax outward.

• Narrow or curved ear canals: These can trap wax inside.

• Overproduction of wax: Some people naturally produce more cerumen than others.

• Improper cleaning methods: Using cotton swabs or objects can push wax deeper instead of removing it.

• Skin conditions (e.g., eczema, psoriasis): These may cause dry skin buildup, contributing to obstruction.

Causes of Dry and Itchy Ears

Dry ears can be just as bothersome as wax buildup for some people. One thing that I would like to point out is that dry ears are a skin issue, not an ear issue.

 Common causes of dry ears include:

• Over-cleaning: Frequent use of cotton swabs can strip away natural oils.

• Aging: Older adults tend to have drier skin, including in the ears.

• Use of hearing aids or earbuds: These can cause friction and trap moisture.

• Skin conditions: People that have underlying eczema, psoriasis, or seborrheic dermatitis are more likely to have ear canal dryness and itchiness.

• Climate: Cold or dry environments can reduce natural moisture.

Symptoms of dry ears include persistent itching, flaking, and a feeling of tightness or irritation in the ear canal. Patients may also report feeling of "wetness" in the ear. This is because irritated skin can weep. It's important to note that this is not the leaking ear we see with infections. 

On examination, we can see skin flakiness around the opening fo the ear canal (meatus) or inside the ear canal, usually accompanied by by redness and irritation. We sometimes see skin fissures as well. 

Ear Hygiene Recommendations

#1 RULE: Let your ears self-clean: Ear wax usually migrates out on its own thanks to the way the skin in the ear is made. Yes, the ear cleans itself!

How do you clean your ears then? 

• Use soft cloths externally: At the end of a shower, the hot steam will help soften the wax that has migrated out. All you need to do is to wipe away any visible wax at the opening of the ear canal with your towel or soft cloth. That's all that's needed for the vast majority of people!
  
  

• Do NOT insert objects into your ears: Cotton swabs, keys, or pen caps (I've seen it all!) can damage the ear canal or eardrum.

• Avoid over-cleaning: Once or twice a week is enough for external ear hygiene. Don't forget, wax is a natural protector.

• Use ear protection: When swimming to prevent irritation from water exposure. This is not needed for everyone.

Treatment Options for Wax Removal

If the steps highlighted in the section above (Ear hygiene recommendations) is not enough to manage your wax situation, then you can consider adding some treatment options to help.

There are several safe and effective over-the-counter (OTC) treatments available:

Ear "Lubricants":

Oil is my #1 recommendation for anyone with excessive wax build up (and for dry ears too actually). Any kind of oil will do the job: olive oil, baby oil, mineral oil, etc. I would recommend purchasing a dropper, so that applying the oil is much easier. 3-4 drops applied once or twice a week should be sufficient for most people. Oil helps soften ear wax and loosens dead shed skin from the living skin, making it easier for the wax to move out naturally. You can then clean it out after a shower like described in the "Ear hygiene" recommendations above.

Softening drops (cerumenolytics):

• Examples: Murine Ear Wax Removal, Cerumol, Hydrogen peroxide

• How they work: 

Cerumenolytics work through one or more of the following mechanisms:

1. 1. Softening or lubricating the wax 
   2. Breaking down keratin and debris in the wax using surfactants or peroxide-based agents

   3. Effervescent action (bubbling) that helps dislodge and lift the wax from the canal walls

• These drops are usually applied with the patient lying on their side, left in place for a few minutes, and then allowed to drain out when standing back up (the excess is wiped).
  
  
• Do not use cerumenolytics IF you have a perforated eardrum, ear tubes, or recent ear surgery without consulting a healthcare professional

Irrigation kits:

• Examples: NeilMed ClearCanal, or any manual irrigation (syringe, bulb, etc.)

• How they work: These use gentle pressure to rinse wax out of the ear canal. Avoid irrigation with only water, as it will remove the natural acidic layer of the skin that protects against infections. Irrigation should be done with a mix (half - half) of water and an acid such as vinegar or peroxide. The irrigation should be very gentle to avoid any pressure trauma to the eardrum. If you feel pain when irrigating, you should stop.

• Do not use irrigation IF there is a hole in the eardrum, ear tubes, or ear surgery history.

Professional removal:

• Performed by a healthcare provider using microsuction, curettage (small instruments), or irrigation for stubborn cases or impacted wax.

Treatment Options for Dry Ears

Since itchy and dry ears are caused by skin issues, care for them the same way you would treat dry skin elsewhere on your body. 

Avoid Over Cleaning:

• Try taking fewer showers, or focus on cleaning your body only. Water can dry out your skin as it evaporates, and shampoo can strip away natural oils that help keep your skin healthy.
• Avoid Q-tip use, ear irrigations and other methods of wax removal (as we pointed out, wax is a natural skin protector).

Ear "Lubricants/Moisturizers":

• Examples:

  Just like for wax cleaning, oil works very well for dry ears. Any oil will do the job (olive oil, mineral oil, baby oil, etc.). There are some commercial oil preparations, such as Curotic, that are designed for the ears that work well.

  You can also use moisturizing creams for the ear canal opening. Ear dryness and flakiness often develop right at the opening of the ear canal. Just like you’d use moisturizer on dry knuckles in winter, applying a moisturizing cream can make a big difference for dry ears.

• Use: A few drops two to three times a week can restore moisture to the ear canal. For the moisturizing creams, apply daily.

Anti-inflammatory drops/lotions/creams:

• If dryness is due to inflammation or skin conditions, a doctor may prescribe drops, lotions or creams with a mild steroid component. The creams are better suited if the irritation is right at the skin opening (meatus) and can be applied with a finger. Drops and lotions are better if the treatment needs to reach deeper in the ear canal.

Avoid irritants:

• Limit the use of earbuds or hearing aids if they worsen dryness. Switch to hypoallergenic tips if possible.

When to Consult an ENT

See an ENT specialist if:

• You experience pain or hearing loss

• There's persistent wax buildup despite home treatment

• You have a history of ear surgeries or ear drum perforation

• You suspect a skin condition or infection

• You are uncertain whether your symptoms are due to wax or another problem

Prompt consultation can help avoid complications like ear infections, chronic blockage, or injury from self-treatment.

Conclusion

Ear wax and dry ears are common concerns but are often misunderstood. With the right approach to hygiene and care—and by knowing when to seek professional help—you can maintain healthy ears and avoid common discomforts. Always treat your ears gently and avoid over-cleaning to let your body do what it was designed to do naturally.