What is ear wax and why does it build up?

Ear wax has a poor reputation, but most of the time it is doing a useful job. It keeps the skin of your ear canals healthy and clears itself out without any help from you. Here is what it is, why some people struggle with it and when a build-up needs attention.

What ear wax is made of

The medical name for ear wax is cerumen. It is made in the outer third of the ear canal, the part nearest the opening, where the skin sits on cartilage rather than bone. That skin holds two kinds of gland: ceruminous glands, a modified type of sweat gland, and sebaceous glands, the oil glands found beside hairs all over your body.

Their secretions mix with flakes of dead skin shed from the canal wall, a few fine hairs and whatever dust has found its way in. Dead skin makes up much of the wax. The rest is a blend of fats, including cholesterol and fatty acids, with some proteins and a little water.

One detail explains a lot of blockages. The inner two-thirds of the canal, lined with thin skin over bone, has no wax glands at all. Wax found packed against the eardrum wasn't made there. In most cases it has been pushed there, usually by a cotton bud, a hearing aid or an earplug.

Why your ears need it, and how they clean themselves

Ear wax isn't dirt, even if it looks like it. It does several jobs at once:

• It moisturises. Without a light coating of wax, the thin skin of the canal becomes dry, itchy and prone to cracking.
• It traps things. Dust, grit and the occasional small insect get caught long before they reach the eardrum.
• It repels water, which protects the canal skin after swimming or a shower.
• It is slightly acidic and appears to have mild antibacterial properties, which may help protect against outer ear infections.

Your ear canals also clean themselves. The skin lining them grows slowly outwards from the eardrum, carrying old wax with it like a very slow conveyor belt, and moving your jaw when you talk and chew helps things along. By the time wax reaches the entrance it has usually dried out and falls away. For most people the only cleaning an ear needs is a wipe of the outer ear with a flannel.

Wet and dry ear wax

Not everyone's ear wax looks the same, and the main reason is genetic. A single variation in a gene called ABCC11 decides which type you make. Wet wax is sticky and ranges from honey-coloured to dark brown. Dry wax is flaky and grey or pale beige.

The same gene variant also affects underarm sweat, which is why people with dry ear wax tend to have less body odour. Neither type is healthier than the other, and both can build up.

Wax also darkens and hardens the longer it stays in the ear, so wax that looks almost black is usually just old. Our guide to ear wax colours and what they mean explains which changes are worth showing a clinician, such as blood or a discharge that smells.

Why some people build up more wax

Most people never need wax removed. For others it is a regular nuisance, usually for one of these reasons:

• Narrow, curved or small ear canals give wax less room to move and more corners to collect in.
• Hairy ear canals, more common with age and particularly in men, hold wax back.
• Hearing aids, earplugs and in-ear headphones block the natural way out and nudge wax back in every time they go in. See our guides to ear wax and hearing aids and earbuds and ear wax.
• Cotton buds, fingers and hairgrips remove a little wax from the entrance and push the rest deeper, where it hardens. Read why cotton buds make ear wax worse.
• Getting older. Wax tends to become drier and harder, and it clears less well.
• Skin conditions such as eczema or psoriasis in the ear canal increase the amount of skin being shed.
• Bony growths in the canal, known as exostoses or surfer's ear, can narrow it in people who spend a lot of time in cold water.

Some people simply make more wax than others. Build-up is also more common in children and in people with learning disabilities, and it can go unnoticed for longer in anyone who finds it hard to describe how their ears feel.

When ear wax becomes a problem

Seeing some wax at the entrance of your ear doesn't mean anything needs doing. It only becomes a problem when enough collects to block the canal. NICE guidance for the NHS recommends removing wax when it is contributing to hearing loss or other symptoms, or when it stops a clinician examining the ear or taking impressions for a hearing aid.

Symptoms often arrive overnight, typically after a swim or shower, when water makes the wax swell and closes the gap that was letting sound through. Our guide to the signs of ear wax build-up goes through each symptom and the ones that point to something else.

What to do, and what to avoid

If your ear feels blocked and you think it is wax, the usual first step is to soften it. The NHS suggests 2 to 3 drops of medical grade olive oil or almond oil in the affected ear, 3 or 4 times a day, for 3 to 5 days. Over the next couple of weeks the softened wax often works its way out, mostly at night. Our guide on how to use ear drops shows the technique that gets the oil where it needs to go.

If your ear is still blocked after 5 days of drops, have it looked at. Many GP surgeries no longer remove ear wax, so you may be pointed towards a community service or a private clinic. Our guide to ear wax removal on the NHS explains what is still available and who qualifies.

How clinicians remove ear wax

The clinician first looks into your ear with an otoscope, microscope or small camera and asks about past infections, ear surgery, a perforated eardrum or grommets. They check the canal and eardrum again afterwards. There are three main ways to clear the wax:

• Microsuction. The clinician watches through magnification and lifts the wax out with a fine suction tube. Nothing wet goes in the ear.
• Ear irrigation. An electronic irrigator sends a controlled flow of warm water into the canal to wash softened wax out. It replaced the old metal ear syringe, which NICE advises against using.
• Manual removal. Fine instruments such as a curette or a small hook lift the wax out under direct vision, often alongside suction.

You may be asked to use olive oil drops for a few days beforehand, particularly before irrigation, which works best on soft wax. Our comparison of microsuction and ear irrigation sets out how the two differ, and what happens at an ear wax removal appointment walks through a typical visit.