Fascinating facts about our ear wax!
What’s the relationship between ear wax and armpits? Intrigued? To understand ear wax, we need to first understand our skin. Why? Because our ear canals are completely lined by skin; ear wax arises from this skin
WARNING!
Please do not read if you are of a squeamish disposition!
What weighs up to 16% of our body weight and stretches up to 22 square feet?
Many patients are surprised when informed that the skin is actually the largest organ in our body. Our skin plays an important role in forming a protective barrier against infection, temperature, and fluid control and making us `waterproof’. Just the surface layer of skin alone can weigh up to 4kg and can stretch up to 22 square feet!! Including the deeper layers of fat, our skin can represent up to 16% of our total body weight!
As with any other living organ, there is an ongoing regeneration process to replace the older cells that eventually shed away from our skin surface. Our skin cells survive for 28 days on average. Put another way, our skin is renewed every 4 weeks and this works out to more than a thousand new skin over our lifetime! The total number of skin cells lost has been estimated to be between 50 to 500 million per day! Some studies estimate that we shed up to the equivalent of our body weight in skin cells over our lifetime! To put this into perspective, up to 50% of dust within our home consists of shed skin cells! Food for thought indeed. Or rather more accurately, food for house dust mites that forage for these dead skin cells!
The average adult ear canal is 2.5cm long and 6 – 7mm wide. The ear canal is S-shaped rather than a straight tube. There is a large natural variability in the width and curvature of the ear canal. It is entirely lined with skin including the ear drum. As with skin elsewhere on our body, ear canal skin sheds and is constantly regenerated. It is a natural wonder that ear canals don’t get blocked with dead skin cells! We can thank our ears’ `self-cleaning’ mechanisms.
What do you get when you mix fat and dead skin cells?
There are special cells within our ear canal skin that produce an oily substance. This oily substance mixes with our shed skin cells to form ear wax. About 60% of ear wax consists of dead skin and the rest includes cholesterol and both saturated and unsaturated fats! The exact composition of our ear wax is genetically determined. Southeast Asians are more likely to have the dry type of ear wax whilst Caucasians are more likely to have the wet type. Recent studies have shown that individuals with dry wax lack a chemical that made them less likely to have underarm armpit odours!
Our ear canal skin is unique in that the skin cells migrate outwards from the eardrum towards the opening of our ear canals. This is akin to the conveyor belt at the airport, albeit a very slow one. Migration speed averages of 1mm per week, which is slower than the rate of our nail growth! This natural migration carries our wax along and prevents our ear canals from being completely blocked with dead skin cells. Ear wax should only be found on the outer part of the ear canals where there is hair-bearing skin.
The amount of wax we produce is highly variable. Despite our ears’ self-cleansing capability, it has been estimated that 10% of children, 5% of adults, and up to 1/3 of older adults experience problems with ear wax. Some of the factors that predispose to ear wax problems include;
- Regular usage of devices within the ear canal. These include;
- In-ear headphones for music
- Hearing aids, especially the smaller ones that sit completely within the ear canal
- Earbuds or plugs for noise or water protection
- Self-performed ear cleaning
Common symptoms experienced by individuals with ear wax include itching, soreness, blocked sensation, hearing loss, and tinnitus. Amongst patients who seek help for their ear wax, their problem most commonly stems from their attempt to self-perform ear cleaning. Whilst the majority of patients seem to be aware that we should not be cleaning our ears, they feel conflicted as they also believe that ear wax is something that is ‘not good’ that needs to be removed. Furthermore, when one’s ears feel itchy it is completely natural and understandable to seek instant relief. Habits are indeed difficult to break!
The commonest `instruments’ used to self-clean ear wax include cotton buds, hair pins, and metal ear wax removals or `ear diggers’. Frequently, this is done after swimming or showering to `dry the ears’. Unfortunately, this would also be the worse time to `self-clean the ears’ as the skin of the ear canals, being wet are at their most `fragile’ state. Tiny scratches would allow penetration of bacteria through the protective function of the skin, resulting in ear canal skin infections.
Even though most individuals are able to self-cleanse their ears without causing any infections, the shape and size of cotton buds mean that ear wax is frequently pushed up against their eardrums. This can be extremely uncomfortable as our ear canal skin and eardrum are well supplied by sensory nerves.
Occasionally after a haircut, stray strands of hair that sit around our ear canal opening can be pushed deeper onto the eardrum during attempts at self-cleaning. This can be extremely distressing for some patients as hair is especially irritating. Ear wax and hair `even deeper in the ears’ is the reason why many patients complain that `the more they clean their ears, the itchier they get!’
There are various contraptions and devices on sale that claim to be safe and effective at removing ear wax. Ultimately, self-performed ear cleansing is a blind procedure in an area where the anatomy is less than straightforward (pun intended). Complications of self-performed ear cleansing include ear infections, perforated ear drums, and foreign objects stuck within the ear canals!! The safest and most effective way to remove impacted ear wax is with the use of specialised instruments under direct microscope magnification and illumination by a trained and experienced doctor.
Many patients ask if there are ways to prevent ear wax from building up so that they don’t need to `dig’ their ears. Both olive oil and sodium bicarbonate drops have been proven to help soften the wax and hence aid their removal when used appropriately. However, there is a tendency to use them only when ears are almost completely blocked. Paradoxically, the softened wax may then completely close off the ear canals and actually worsen the blockage! A better strategy may be to use these drops `preventatively’ every 2 to 3 weeks to help prevent wax from building up.
Best to leave it to nature!
However, it should be emphasised that for the vast majority of us, it is best to just leave our ear canals alone and rely on our natural self-cleansing mechanism to expel the ear wax. Last but not least, ear wax has natural anti-microbial properties. Ear wax is naturally mildly acidic and together with the presence of friendly bacteria (commensals), actually help inhibits the growth of harmful bacteria and fungus.
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