Earwax, technically known as cerumen, is produced by glands inside your ear canal. It may be a gray, orange or yellow waxy substance, and is designed to protect, clean and lubricate the ear canal. It also provides protection against insects, water and bacteria.
The wax consists of dead skin cells, hair and secretions from glands in the outer ear canal. Other substances include lysozyme, an antibacterial enzyme, fatty acids, alcohols and cholesterol. In fact, earwax really isn’t wax at all, but a mixture of water soluble, self-cleaning agents with protective, lubricating and antibacterial properties.
Excess earwax normally makes its way slowly out of the ear canal, carrying with it dirt, dust and other small particles. According to guidelines issued by the American Academy of Otolaryngology-Head and Neck Surgery Foundation, up to two-thirds of people in nursing homes may suffer from a condition in which the wax collects to a point where it can completely block the ear canal.1
Earwax Buildup in the Elderly Increases Other Health Risks
When a buildup goes unrecognized in the elderly it can pose serious problems. Normally, the earwax is part of a self-cleaning process, but in 10 percent of young children, 20 percent of adults and more than 30 percent of the elderly, the wax collects and is not expelled.2 In 2016, the U.S. federal Medicare program paid for nearly 1.7 million earwax removal services. Dr. Seth Schwartz, Seattle otolaryngologist who was instrumental in updating the recent guidelines, said:3
“In elderly patients, it’s fairly common. It seems like such a basic thing, but it’s one of the most common reasons people present for hearing-related problems.”
Excessive earwax is responsible for nearly 12 million visits to a health care provider each year, including 8 million who require removal in the office.4 Schwartz advises the best way to control earwax is to leave it alone. However, this can backfire when the ears of senior citizens in residential care go unchecked.
A blocked ear canal will not be visible from the outside, but requires a professional with an otoscope to tell if cerumen is blocking the canal. The effects of removal maybe immediate, especially in an elderly population.5 A small study6 found significant improvements in hearing and cognitive performance in those with memory disorders when an impacted ear canal was cleared.
Julie Brown, assistant director of nursing in the memory support unit at Silver Ridge Assisted Living, reports impacted earwax is particularly problematic for those with dementia, as it exacerbates hearing loss, which then impedes communication and increases aggression and other difficult behavior.7
Brown finds as soon as the wax is cleared, even behavior improves quickly. When the ear canal is impacted with earwax it can trigger ear aches, infections and other problems. When it’s lodged in a specific way, the wax may trigger a branch of the vagus nerve supplying the outer ear, stimulating cough.8
Hearing Loss Related to Cognitive Decline
According to Jackie Clark, board certified audiologist and president of the American Academy of Audiology:9
“The excessive amount of earwax can cause hearing loss or ringing in your ears. Some people experience vertigo, which increases the risk of falling. Right now, we see some correlation between hearing loss and cognitive decline.”
Hearing loss occurs in nearly 1 in 3 people over the age of 65 and in nearly 50 percent of those over 75. This statistic makes hearing loss one of the most common conditions affecting older adults, which is significant, as hearing health is important to communication and overall quality of life.
In a study10 funded by the National Institute on Aging, research data indicated hearing loss can impact cognition and dementia risk in older adults. Another study published in the Journal of the American Medical Association11 found hearing loss is independently associated with accelerated cognitive decline in community-dwelling older adults.
Yet another study from Johns Hopkins University12 found older adults with hearing loss are more likely to develop problems thinking and remembering than those with normal hearing. In this study, volunteers with hearing loss underwent repeated cognitive testing over six years.
The data demonstrated up to 40 percent faster cognitive decline in the hearing impaired than those whose hearing was normal. The levels of declining function were directly related to the percentage of hearing loss. Lead author, Dr. Frank Lin, commented:13
“Our results show that hearing loss should not be considered an inconsequential part of aging, because it may come with some serious long-term consequences to healthy brain functioning.
Our findings emphasize just how important it is for physicians to discuss hearing with their patients and to be proactive in addressing any hearing declines over time.”
Why Ears Need Healthy Amounts of Wax
Your ears produce earwax constantly, so ideally you maintain the right amount in your ear canals. It’s best to leave your wax alone and not try to remove it with cotton swabs or other devices. In fact, too little earwax in your ear canal can leave your ears feeling dry and itchy.
Earwax functions to protect your ears and provides lubrication. The compound prevents dust, bacteria and other germs from entering and damaging your ear, traps dirt and slow the growth of bacteria. There are two types of earwax: wet, which is sticky and yellow or brown color, and dry, which is crumbly and lighter colored gray or tan.
You have a single gene that determines the type of earwax you have. Dry earwax is more common in individuals from East Asian countries, while wet earwax dominates in African and European populations. Interestingly, the same gene that determines dry earwax is also responsible for reduced underarm body odor in individuals from China, Japan and Korea.14
The movement of earwax through your ear canal is aided by movements of your jaw, such as talking or chewing. Once it reaches the outer ear it simply falls out or is removed during a shower. Symptoms indicating you have an excess of earwax buildup include:15
Noticeable wax accumulation
Tinnitus or ringing in your ears
Foul odor coming from your ears
Partial hearing loss
A sensation your ears are plugged
Feeling of fullness in your ears
Discharge from your ears
Omega-3 Deficiency May Be the Issue
If you have trouble clearing wax, consider increasing your intake of omega-3 fats, as frequent excess buildup of earwax may be traced back to an omega-3 deficiency. The remedy is simple: Eat more omega-3-rich fish or take a high-quality, animal-based omega-3 supplement like krill oil.
Animal-based omega-3 fats consist of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Good dietary sources include sardines, anchovies, mackerel, herring and wild-caught Alaskan salmon. Omega-3 deficiency is common in a western diet, and the problem is worsened by the fact that most processed foods are high in omega-6 fats. This further increases the imbalance between omega-3 and omega-6 fats.
Your brain, bones and mental health are all impacted by omega-3 fats. How much you require depends on your body size, age, health status and the type of omega-3 fat you’re consuming. While there is no set recommended standard dose, some health organizations recommend a daily dose of 250 to 500 mg of EPA and DHA for healthy adults.
It’s important to remember this applies to animal-based EPA and DHA and not ALA found in plant-based omega-3 fat. To learn more about the differences between plant- and animal-based omega-3, and why you cannot use them interchangeably, see “The Critical Differences Between Omega-3 Fats [and] Plants and Marine Animals.”
Research funded by the National Institutes of Health16 highlights the value of adequate levels of EPA and DHA omega-3 fats in assessing your risk for developing certain diseases. Increased levels of omega-3 reduced cardiovascular disease risk, and a strong association was found between low levels of omega-3 and death from all other causes.
The Dos and Don’ts of Cleaning Your Ears
Cotton swabs are not meant to be inserted into your ears, and doing so may damage your eardrum, skin or the tiny ossicle bones critical to hearing. In fact, inserting any object lnto your ear could damage your skin and push the wax deeper, blocking the ear canal completely, and may lead to hearing loss, dizziness, ringing and other symptoms of ear injury.
Another dangerous practice is the use of ear candles. These have been used as far back as 2500 B.C. when ancient cultures made reference to the use of candling in parchment scrolls discovered in the Orient.17
Also known as ear coning, studies18,19 have demonstrated injury to the ear during the process, including the deposit of candle wax within the ear canals, external burns and perforated eardrums without successfully removing earwax.
If you have excess earwax, there are a few things you can do to help encourage the wax to move out. If you are otherwise healthy, do not have ear tubes or an eardrum perforation, and do not have diabetes, you can safely attempt to clear excess wax from your own ears.
The simplest way is to first soften the wax by putting a few drops of olive oil, coconut oil or normal saline in your ear. Then, pour a capful of 3 percent hydrogen peroxide into the ear to flush the wax out. You will hear some bubbling, which is completely normal, and may possibly feel a stinging sensation. Once the wax is softened it often moves out of the ear canal on its own.
Using hydrogen peroxide in your ears may also help improve respiratory infections, such as colds and flu. If the wax is troublesome, you may need to see your physician for irrigation of the ear canal with a syringe, or removal with appropriate instruments. This should be limited to a professional since, if done improperly, it can damage your eardrum.