Earwax: It’s Weirder than You Imagine

And for some people, more disgusting, too

“Doctor Mary, my ear feels like there’s fluid stuck in it and sometimes I can’t hear what Alyssa is saying. It’s been bugging me for a month, just a little bit, but then this week, it started really bothering me. It’s only the left one; the right one is fine. I keep trying to pop my ear like I was in an airplane but that doesn’t help at all. Everything sounds like it’s under water and sometimes it makes crackling sounds.”

“Well, let me take a look, Ben. Anything else going on today?”

Ben’s wife, Alyssa, answered for him, “He keeps saying he can’t hear me and it’s annoying. We went out to lunch before we came in today, and I felt like I was yelling loud enough that everyone at the diner heard me.”

“When the problem is about hearing, I find that the patient’s spouse almost always shows up at the appointment. It seems that they suffer more than the patient.”I laughed with Alyssa and Ben as I gestured for Ben to sit on the exam table.

“I’ll start with the good ear,” I pull on the external ear (its fancy name is pinna) to straighten Ben’s ear canal and put the tip of the otoscope in (that’s the little flashlight you’ve seen doctors use). 

“Well, there’s a bit of wax here, but I can see most of the ear drum and it looks fine, as we expected.”

I walk around and pull on the left pinna and slip the otoscope in. “Hmmm.” I pull harder and wiggle the tip around, “No luck. Guess what I see in there?”

“Nothing?” Ben suggests. 

About half of my patients make that joke, and I laugh every time. “Nope. Wax. All I can see is earwax.”

“I clean my ears after every shower!” Ben says defensively.

“I’m sure you do. Earwax has nothing to do with not being clean! Want to know what earwax is? It’s kind of disgusting. It’s skin cells shed from your ear canal mixed with secretions like oil the hair follicles and modified sweat gland in your ears make.”

“No way!” Ben is engaged now.

“And, Ben, I should tell you that you’re really not supposed to put anything smaller than your elbow in your ear canal.”

Ben moves his arm around like he’s trying to put his elbow in his ear. “Then how do I clean my ears?”

“Your ears are self-cleaning! When you move your jaw, like to chew or talk, it pulls on your ear canal, and that keeps stuff from getting stuck in there. The wax just falls out on its own. The reason you shouldn’t try to clean your own ears is that you can’t see what you’re doing in there. You could easily push a Q-tip right through your eardrum or scrape the sides of your ear canal. I’ve seen people do both of those things. If wax gets stuck and you really can’t get it out, you can use oil to soften it.”

“Extra virgin? Or canola?”

This is the first time I’ve heard this joke and I think it’s funny. 

“Some people do use cooking oil or you could use baby oil or you can buy special ear drops at the drug store. Any of those things work. If you think your ear drum might have a hole in it, don’t use those things. In that case you’ll need to see an ear, nose, and throat doctor. After you use drops for a day or two, make an appointment to come in and we can wash your ears out. 

“Probably those crackling sounds you hear are from a piece of ear wax shifting around. Sometimes a tiny bit of water will get trapped behind a chunk of earwax. That can be very uncomfortable and you might have gotten that, too.

“Now, here’s an interesting thing, Ben. Earwax comes in wet and dry forms. You have dry earwax. I can’t remember what Alyssa has.”

Alyssa is sitting up straighter now. “Take a look, please!”

I put a new, clean plastic piece on the business end of my otoscope and look in her ears. “You have wet, Alyssa. 

“Your son could have either wet or dry. Remember the thing with the peas and genes you learned in high school biology? Dry wax is recessive. That means Ben has two dry wax genes. Alyssa has a wet wax gene, and we can’t tell what the other one is. If she has one wet and one dry, your son could have either kind of wax. If she has two wet, then any children you have will have wet earwax.

“With little kids with wet earwax you can sometimes see their earwax, kind of leaking out of their ear, looking a little bit like honey.  Sometimes parents of kids with wet earwax will take a kleenex and rub it on the end of the ear canal to clear up the ears. But for kids with dry earwax, a small chunk might occasionally fall out, but there won’t be anything to clean up on the ear.”

Alysa says, “I know just what you mean. I used to wipe Martin’s ear all the time when he was little. Now that he’s big enough to complain when I do it, I’ve encouraged him to wash his ears when he shampoos his hair. It’s hard to keep him anything like clean!”

“So, your son has wet wax, like you, Alyssa. The good thing about wet wax is that you’re less likely to get an ear full of wax like Ben has because the wet kind just kind of drains out. The bad thing about wet earwax is that it is associated with B.O.”

Alyssa and Ben’s eyes are both popped out now. “Yep. Further research is needed into the details and association is not causation, of course.”

“Ben, however, smelly or no, is stuck with an earful of wax. If I could see the wax was clearly a chunk, I could use a tiny curette - a little spoon - to pull the wax forward. But that’s not safe because I can’t see an edge to pull on. The alternatives are to either wash it out here, send you to the ear, nose, and throat doctor - they have a really tiny vacuum cleaner that can suck it out, or try to put up with it until it eventually comes out on its own. 

Ben replies, “If you can get this stuff out of my ear right now, let’s go for it.”  Ben glances at Alyssa, who nods in approval.

I say goodbye to Ben and Alyssa. I find my assistant, Chloe, and tell her what’s needed. Then, I go off to see my next patient. 

Chloe has Ben lie down on his side on the table, with his plugged-up ear facing up. She puts a couple of drops of oil in his ear and tells him to lie still and that she’ll return in a few minutes. During that time, she’ll likely go room our next patient. After that, she’ll prepare the ear-washing water, and then come back to wash out Ben’s ear.

Preparing the ear-washing water is a crucial step. The water temperature must be very close to body temperature. If it isn’t, the patient will become extremely dizzy. 

I assume that everything will go right and that Chloe will have no problems, but even from two rooms away, I hear the unmistakable sound of a person vomiting. I start worrying. How could Chloe have gotten the water temperature so wrong that Ben became nauseated and vomited? Or was he just incredibly sensitive? No one came to interrupt me so I figured Chloe had the vomiting situation under control. My current patient and I both ignored the vomiting sounds, and we finished our visit like everything was normal.

I returned to Ben and Alyssa to find out what had happened. I was surprised to find that Ben was fine, but Alyssa was lying on the table! Ben told me what had happened. 

It turned out that seeing an impressively large piece of wax come out of Ben’s ear was more than Alyssa’s stomach could handle. It’s well-known in the medical profession that many people find earwax to be nauseating. It is probably the most detested bodily fluid among the medical assistants at primary care clinics. Most of them would rather clean up vomit than earwax. Today, poor Chloe got stuck doing both. 

Alyssa had no idea that she was one of those people who are grossed out by earwax. On top of that, Ben tells me that Alyssa is newly pregnant and her morning sickness was extending until late afternoon. 

After Ben relates all of this to me, I ask him, “are you hearing better?”

“What?” he joked, cocking his head sideways.

“Actually, my ear feels so much better. I guess the crackling and itching was probably that chunk moving around in my ear canal.”

“I bet so, Ben. Let’s hope for everyone’s sake that your next baby has wet ear wax! I don’t want poor Alyssa to be traumatized by ear wax again! Oh, and by the way, congratulations!”

While Ben and Alyssa walk themselves to the front desk, Chloe comes in and tells her side of the story.

“She puked so fast I didn’t even have time to get the elephant condoms out!” ‘Elephant condoms’ are what we call the barf bags that every exam room is stocked with. Poor Chloe had to clean up the vomit from the floor.

“Yeah, I’ll be making a note in her chart,” I told Chloe, “Prone to vomiting. Use caution.”

*All patients and staff members are amalgams of patients and staff I have had over the years. 

**Nothing in this article is meant to be personal medical advice. If you want to know anything about your own ear wax, see your personal doctor.