Earwax and Ear Infections: All Things Earwax
We’ve all been there. A child seems uncomfortable and we wonder if they have an ear infection. Could that be what’s making them cry? Wouldn’t it be nice if just looking at a few crumbles of ear wax could tell us if the ear is infected? People commonly ask if ear wax changes color when someone has an ear infection. Or, some may want to know what ear wax looks like if you have an ear infection.
This post covers all things ear wax, also called cerumen. It will review what ear wax is, why humans have it, what to do about ear wax at home, and when a doctor or other health care professional may need to help remove it. We’ll start with the most pressing question:
What does ear wax look like when you have an ear infection?
With most middle ear infections, a person’s ear wax does not change color or texture. This is the case if the ear drums are intact. More on the ear drum and anatomy later.
If someone has a middle ear infection, but has had tubes placed in their ears or if the ear drum has burst, then there may be some discharge in the ear canal. The discharge may look like blood or pus. This blood and pus can be mistaken for changes in the ear wax itself. Everything may literally run together.
On the other hand, if someone has an outer ear infection (also called swimmer’s ear), there may be discharge or fluid in the ear canal as part of the infection. This fluid can mix with the ear wax, so that everything may appear sort of wet, runny, crusty, and white or green. This is also pretty uncomfortable, so the infection may be more obvious.
Ear wax protects and cleans ears.
Now, let’s step back and go over a few basic facts about earwax. Earwax is made in the outer two thirds of our ear canals. It helps keep our ear canals clean and lubricated. It’s made naturally and it also usually falls out on its own. Every time we yawn, cry, chew, or otherwise move our jaws, it works its way out. As it moves outwards, it can collect hair or other debris. This is one way it helps keep ears clean.
It can even be normal for a ball of wax to fall out of your ear. Its just doing its job!
What does normal earwax look like?
Normal earwax can vary from dry white or grey to a sticky darker brown. Dark orange earwax can be normal. Genetics plays a role in the type of earwax each person has.
What’s not normal about earwax?
It’s not normal for earwax to be stuck in the ear canal or for it to cause any discomfort. Even though this isn’t normal, it is common. Also called an impaction, if earwax is stuck in someone’s ear, they may need a little help getting it out. Depending on the study we reference, impacted earwax affects between 2-6% of healthy adults and up to 10% of children. It’s much more common in the elderly.
A child’s pediatrician can be the first step to see if earwax is impacted and to see if they need help removing it.
There are two main situations in which a physician or health care professional may recommend removing ear wax. (Remember that most of the time it works its way out on its own).
- The child may have a middle ear infection, but the earwax could block the view of the ear drum, also called the tympanic membrane. A middle ear infection diagnosis (also called otitis media) requires a good view of the ear drum. We can make pretty good guesses based on symptoms and how a child is acting, but cannot make an accurate diagnosis without clearly seeing that ear drum.
- The ear wax can cause discomfort. Sometimes, the earwax is so impacted that someone has trouble hearing. Or they have an uncomfortable full feeling in their ear. (Little kids may just say it hurts). Some people also complain of itching or even ear ringing due to earwax buildup.
In both of these situations, a physician may want to remove it. I don’t recommend parents or patients try to remove the ear wax on their own, unless a professional has examined the ear first with an otoscope (that tool with the light used to examine ears).
How a Doctor Removes Earwax
A pediatrician, family physician, nurse practitioner, physician assistant, or ENT physician (otolaryngologist) may remove ear wax in the office. There are a few different methods:
- scooping it out with a small tool called a curette
- squirting it out with a liquid (often warm water)
Some also use a suction device or forceps. And finally, some may recommend a family use drops at home that help dissolve or break of the wax so that it can come out more easily later. Ear drops, such as Debrox are not for kids under age 3.
Again, especially for kids, I don’t recommend any home remedies for ear wax unless the ear has been examined first. If there is an injury, such as an ear drum perforation, that the family isn’t aware of, things like drops can cause harm.
A note on young kids and earwax removal.
When removing earwax from a young child or toddler, it helps to have a supportive family member assist. Each clinic and health care provider will have their own preferred methods, and can usually direct the family member to the best position. Sometimes the toddler can sit in a parent’s lap while their ear is flushed out.
When asked, many kids say that ear wax removal does not hurt, but it does feel strange. It’s not every day that someone gets their ear canal tickled.
Risks to Earwax Removal
Each health care professional can discuss the risks associated with their chosen method of earwax removal. They may mention irritation to the inside of the ear canal, especially when using a tool like a curette. Sometimes this irritation can lead to some minor bleeding. More serious injury is possible, but less likely.
Sometimes, a physician or primary care provider isn’t able to get the wax out. This happens. In these cases, they may refer to an ENT specialist.
How to Care for Ears (and Earwax) at Home
So, if you’re not supposed to flush or scoop at your child’s earwax, what can you do? The best thing is to allow the earwax to do its job of working its way out. Gently cleaning the ears with a warm wet washcloth is usually enough. Clean whatever you can clearly see, but don’t go digging.
(I also discuss this in my booklet about newborns. Find it here).
This information applies to otherwise healthy children.
Some children (and adults) with chronic illness or those on specific medications may need different approaches to their earwax.
For example, individuals who wear hearing aids are more likely to have earwax impaction. So, they need more regular exams and are more likely to need professional help removing the wax in order to optimize their hearing.
A few tools to avoid when dealing with earwax
Again, a wet cloth may be the only at-home ear tool you need. But, if you’re tempted to be more aggressive, please consider avoiding cotton swabs and ear candling:
- Q-tips or cotton swabs are not for cleaning inside ears. Even if it seems they’re scooping some of the wax out, they usually just pack it in more, leading to the earwax impaction discussed earlier. The wax gets rammed deeper and more firmly in place in the canal. And, sometimes the cotton tip get stuck in the ear canal too! While we’re at it, consider this a reminder to not put anything else in a child’s ears either. The risks are too great.
- Ear candling or ear coning is not safe or effective. This refers to when a hollow type candle or cone shape is placed in the ear and the other end is lit on fire. The claim that this helps remove cerumen is false. There are also significant risks, including injury to the ear drum and hair catching on fire (!).
Summary: Earwax is a normal part of our ear canals.
Ear wax helps keep our ears clean and healthy. And, it varies from one person to the next. With most middle ear infections, it doesn’t change much. However, if an ear drum has perforated or if the ear infection is an outer ear infection, the wax may get mixed up with other ear discharge, so everything will look different.
Most earwax needs no special treatment. That being said, if a doctor needs to see the ear drum clearly, or if the ear wax buildup is causing discomfort, it can be removed.
Maya M. Mahmood, D.O., FAAP is a board-certified pediatrician and mom. She is passionate about parents having evidence-based information to help their families be healthier.
Disclaimer:
This is for information only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
