SHOW NOTES

Ear wax is normal—and useful—but excessive buildup can temporarily reduce hearing and interfere with devices like earbuds and hearing aids. In this conversation, our clinicians explain what ear wax is, how it forms, and the safest ways to remove it without risking injury.

What causes ear wax?

Ear wax (cerumen) is a mix of oils, skin, and debris produced by glands in the ear canal. Genetics, canal shape, and habits (earbuds, hearing protection, or hearing aids) can all influence buildup. Skin migrates outward from the eardrum like a conveyor belt; devices that block the canal can slow this process, letting wax collect. Some people naturally make drier or stickier wax—both can be normal.

Ear wax removal

At home, softeners (e.g., carbamide peroxide drops) can loosen hard wax, but softened wax still needs to come out. For rock-hard plugs, in-office softening and careful removal may be necessary. Avoid Q-tips—they can bruise the canal or push wax deeper. And skip ear candling: it’s not proven to remove wax and poses a burn/fire risk. When in doubt, consult a licensed audiologist to choose a safe plan for your ears.

How to manage, remove, and prevent buildup

• - Use a clinician-recommended softener for several days before a scheduled cleaning if you tend to form hard plugs.
• - If advised by your provider and you have no eardrum perforation or tubes, gentle warm-water rinsing in the shower can help maintenance.
• - Limit canal “poking and prodding.” Follow the rule: nothing smaller than your elbow in your ear.
• - If you wear hearing aids/earbuds, set a routine check—wax guards and periodic cleanings can prevent “sudden blockage” days.

When to see an audiologist

Schedule an exam if you notice sudden fullness, decreased hearing, feedback from hearing aids, pain, drainage, a foul odor, or if you suspect infection (foamy, wet debris). Audiologists can safely evaluate and remove wax and will refer to primary care or ENT when infection or another condition is suspected. No medical claims are made here; individualized care matters.

Key takeaways & tips

• - Earwax protects the ear; problems arise when there’s too much.
• - Softening isn’t the same as removal—plan for extraction.
• - Avoid ear candling and Q-tips in the canal.
• - Set a proactive cleaning cadence (often every 3–6 months for “wax producers”).

TRANSCRIPT

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​[00:00:00]

Dr. Emily Johnson: Hi, this is Dr. Emily Johnson.

Lindsey Doherty: Lindsay Doherty.

Dr. Dawn Heiman: And Dr. Dawn Heiman.

Dr. Emily Johnson: And today, we are gonna talk about the mysterious substance that comes from your ears... wax. Otherwise, known as cerumen. And there's a lot of different feelings about ear wax.

Some people love to watch those viral videos of seeing it get removed. Other people have no interest in what I put in the tissue after [00:01:00] we take it out, but we're gonna talk about kind of what it is, where does it come from, the purpose of it, and then different ways that we can remove it in office, as well as some DIY removal techniques that either work at home, or maybe we should back away from the candles.

Dr. Dawn Heiman: So, some people they schedule an appointment. Because they saw a video, and they're like, "That's so cool. I want that done." Whereas other people might be ashamed of it.

Dr. Emily Johnson: Yeah, absolutely. Of where they're like, "Ooh, like does having wax makes me dirty?" Or the amount of times that we started an appointment not even related to wax, and they're like, "Oh, so sorry I didn't clean my ears before coming today."

Lindsey Doherty: Right.

Dr. Emily Johnson: And I'm like, "There's no need. No need. It's not a problem at all."

Dr. Dawn Heiman: Oh. [00:02:00] Do you know how many times I've looked in someone's ear and I was like, "Ooh, did you clean your ears with a Q-tip before you came?" And they're like, "Um, yeah, I didn't wanna come in and have you see stuff in my ears." I'm like, "That's why we scheduled this."

You have bruising on in your ear canal now. Or even on the eardrum. I can see the little mini hematomas.

Dr. Emily Johnson: Right, right.

Dr. Dawn Heiman: No, don't be ashamed.

Dr. Emily Johnson: Be proud of your wax.

Lindsey Doherty: Yeah. It's not like the dentist. Come as you are.

Dr. Emily Johnson: No pre-cleaning necessary. Everybody has some sort of wax. So the wax that's in your ears is a combination of different things.

So it's oil. It is debris. Sometimes it's flaky skin. And everybody's wax is a little bit different in texture and color. And there is no right or wrong color of wax as long as it really is wax in your ear canals. [00:03:00]

So, if you see somebody else's wax on a video, and you're like, "Ooh, mine wasn't that color, no problem."

It's just different shades. It all just depends on the type of oil that the little hair cells in your ear canal secrete. And genetics plays a role in that too. Some people are just waxier than others, and if you're waxy with a curvy ear canal. It just means we're gonna have to take it out a little bit more frequently.

Lindsey Doherty: It's gonna get trapped.

Dr. Dawn Heiman: Or if you've been wearing hearing protection, or earbuds, or you have new hearing aids... people are always asking, "Why is it that I never had a problem with ear wax until I wear hearing aids? Do my hearing aids make ear wax?"

Well, you have this natural migration process. From the eardrum, new, fresh skin grows and develops on your eardrum, and then that starts to migrate down your ear canal, out. Kind of like a snake that sloughs its [00:04:00] skin. It leaves the shell. This is kind of the same thing, but some people, they're genetically more predisposed to produce globular stuff. Men too, but women, as they start to age, their skin starts to become more dry, and they can get this flakier-like substance.

Some people have conditions like Parkinson's disease. My Parkinson's patients, they tend to have oily, oily skin and excessive production of ear wax, because right there in that ear canal, that's a sweat gland. It's a sebaceous gland. When you sweat, or you're doing different things, it's like your armpits. You'll have a white shirt, and you get the yellowing. It's from the excretion of the oils in your ear. The oils bubble up. But some people, it's thinner, more globular.

Have you guys ever heard about a study that they did that they were looking at people with earwax and their diet, in different regions of the world?

Dr. Emily Johnson: No, but that would make sense.

Lindsey Doherty: I had thought about it [00:05:00] because of the 'eat right for your blood type' phenomenon that was going on and how, where you lived, climate, did you live out where there's a lot of bugs and stuff like that. That had an influence on your blood type and everything.

Dr. Dawn Heiman: I don't know about that. That's really interesting. I honestly don't even know my own blood type. I couldn't tell you right now what it is. I keep trying to look it up, and no one has a record of it.

Dr. Emily Johnson: You should know that!

Dr. Dawn Heiman: Right? There was a study done years ago that I remember when I was in my doctoral class on cerumen management, earwax , where they looked at people that were in the eastern hemisphere of the world versus western.

And the hypothesis was that people that are from Asia, let's say, have a dry, flaky wax, genetically. And western hemisphere, genetically, they have a globular, wetter, darker, golden wax. And they did find, it was a significant finding, that they believe it's diet.[00:06:00]

So if you have a healthier, cleaner diet. You're eating more rice, vegetables, fish, things like that. Versus beef, french fries, and the fatty oils and all of that, and they think they proved it in that one study, but it causes ear wax that is softer, sticky, fatty. Versus thin, dry, not a lot of buildup. But then one is itchy and the other one might not be, you know?

Dr. Emily Johnson: Right. Wax is there for protection purposes as well. It's an antimicrobial. It's an antifungal. It deters things from going into your ear canal that don't belong there, including bugs and things.

So I wonder how much evolution has played into it, of people who tend to be more outdoors, or in places with a lot more bugs, if their wax has somehow adapted to deterring [00:07:00] insects from going in there. Or if they happen to be in an area where... I don't know. This is what I think about at night.

Dr. Dawn Heiman: Well, why do some people get external ear infections and others don't? One person is a swimmer, and the other person is a swimmer, but one always has swelling of the ear canal and dry, flaky wax. They're in pain every time they go on vacation. And others, it doesn't bother them.

Lindsay, I know you have a golden doodle. I have a golden doodle, and I have a poodle. Like these poodle-based dogs tend to get external ear infections. They tend to have more allergies. They're more allergic to grass and pollen and all that kind of stuff, and humans could be the same way, where some people are more susceptible to building up stuff.

Let's talk about that. Let's say you think you have ear wax, but it turns out you have something else.

Dr. Emily Johnson: Mm-hmm.

Dr. Dawn Heiman: It's otitis external, let's say. Or it's an infection that's completely different than what you assumed and were treating at home.

Dr. Emily Johnson: Right. [00:08:00] Several times now, we've had people come in thinking that their ears are waxy because they see debris coming out of it.

And, we actually have video otoscopes in our office that can show you what the inside of your ear canal looks like, which is really cool. I mean, if you're into that kind of thing, to see what your ear wax looks like.

But - while wax can come in different colors, substances, different textures, things like that - if we look in, and it is foamy white, lots of moisture and lingering in a damp look, we're likely going to refer you somewhere just to be evaluated for any sort of infection or something else going on. Where it doesn't look like typical wax. Because we know that even if we just remove it, whether [00:09:00] by manually taking it out with the curette or washing it out with water, if it's an infection, it's just going to continue to come back.

It shouldn't come back if it's just wax, and it shouldn't come back in the same texture like this. There's likely something else going on, and we're gonna refer you out for that because infections are outside of our scope of practice, and that's why we refer to our colleagues: ENTs, otolaryngologists or primary care physicians.

And sometimes ENTs are really booked out. They're quite popular, especially as we're entering cold and flu season, and we get lots of ear infections going on. It is something that primary care could look in your ears and evaluate for, as long as they have some experience of what to look for in the ear.

Dr. Dawn Heiman: Yeah. I think my biggest red flag is: if I go to lean in and look in your ear and I smell it...

Dr. Emily Johnson: Oh, it smells. Yeah...

Dr. Dawn Heiman: Crazy, crazy, [00:10:00] crazy. No.

Dr. Dawn Heiman: What's the weirdest thing you've seen in an ear? That you had to remove or refer?

Dr. Emily Johnson: Oh, um... a little Barbie shoe. Yeah. Back in my pediatric days...

Lindsey Doherty: I forgot!

Dr. Emily Johnson: Yeah, a Barbie shoe was in there, and I'm like, "That looks like a hot pink high heel."

And it was! And it was encased in wax that had built up, and it was quite hard. So you had to soften it and then get it removed. And I was like, "Oh... well, that wasn't on my bingo card of what I thought I'd be pulling out of people's ears this morning!"

But kids are kids.

Dr. Dawn Heiman: I had a primary care office; the resident sent over a little one for an ear infection. I was at PEDS Rehab, and I had a student with me, and you're supposed to, as a clinician, never *gasp*, you know, jump or whatever, right?

Dr. Emily Johnson: Right.

Dr. Dawn Heiman: And so they send over this kiddo, and I go [00:11:00] to look with the otoscope, and it's this bulging, orange and yellowish-red, what looked like an eardrum. And then I thought, "That's anatomically impossible. The eardrum is bulging right there.

Dr. Emily Johnson: You would never make it out that far.

Dr. Dawn Heiman: I let the student check. You can never... right? I was like, "Oh my gosh." Right? And I look, I look, I look, I look, and I see a little divot of dark, and I was like, "That's a bead."

Lindsey Doherty: What?

Dr. Emily Johnson: Mm-hmm.

Dr. Dawn Heiman: I was able to hook a bead and pull it out.

It was a bead from hair or from a necklace, bracelet, those little things.

Dr. Emily Johnson: Yeah.

Dr. Dawn Heiman: But it was just the right size, shape, color.

Lindsey Doherty: Wow.

Dr. Dawn Heiman: That it looked like a bulging, angry, ear-infected eardrum, but it was too shallow for it to actually be the eardrum. But they didn't know, but good on them to refer.

They knew they could get into see me faster, but that was crazy. I did remove an ant once, a large one, from...

Lindsey Doherty: That was the weirdest thing that [00:12:00] I saw, was when you said, "Lindsay. Check this out." And it was...

Dr. Dawn Heiman: She was so calm.

Lindsey Doherty: It was broken into three different sections, and it was just there.

Dr. Dawn Heiman: Because that was the only way to remove it.

Lindsey Doherty: Yeah.

Dr. Dawn Heiman: I pulled on a leg and then... so it was black and shiny, and she was saying that her ear kind of hurts when she puts in her custom hearing aids. And I was like, "How long has this been going on?" She's like, "Oh, a number of weeks." I'm like, "Okay." You know.

I go to look, and if you have had trauma of your ear canal and had a pretty good bleed, it will scab over with a shiny black scab. And you want to be careful as a clinician removing that because, underneath, you might remove that scab, and here comes the eruption of blood again.

Especially if someone's on a blood thinner or something like that. Right? So I didn't really wanna touch it, and I didn't wanna remove the scab 'cause it was right there and like, oh, in my mind, she'd been doing some damage by pushing that in, and she scratched herself or something.

So then [00:13:00] I try to like, just tap it, touch it, and it moved. And I was like, "Okay, it's not... it's not completely attached? That's cool." And I get my alligator forceps and start to pull out and they're like, "Wait, there's little shrapnels in there, right?" Because she had been using her hearing aid. I think she broke it up a little bit.

It was a long, big... the largest ant I've ever seen, in my mind. I pulled out the butt, and then there was still the middle section and like some legs and then the head coming out. But she was so calm about it. I was like, "So here's what I found in your ear..." She's like, "Okay."

And she lives in a very nice gated neighborhood. Ants happen. Bugs happen. She could have been on vacation in the Caribbean, and they walk in there.

Dr. Dawn Heiman: The craziest one I ever saw though was when I worked at a children's hospital in Philly, and... okay, if you don't wanna hear gross bug stories, you might want to shut this off right now. We don't wanna traumatize your [00:14:00] kids.

So cockroaches can't back up. They go in forward, and then they scream. And every time something touches your eardrum, it's painful. So screaming cockroach up against the eardrum. So the way to remove them would be to drown them, not in water, but oil because cockroaches have evolved over time where they're like tanks of the bugs.

Dr. Emily Johnson: They can swim now or something.

Lindsey Doherty: Mm-hmm.

Dr. Dawn Heiman: They can swim. Yeah. So you fill it up, wait till it stops screaming and moving, and then you just pull the whole thing out. Crazy.

Dr. Dawn Heiman: But it happens, right?

Dr. Emily Johnson: Mm-hmm.

Dr. Dawn Heiman: That's why in those that show, Survivor, they have the mask. They sleep with it over their nose, mouth and ears - ear, nose, and throat - so that bugs don't crawl in while they're sleeping.

Lindsey Doherty: I've never watched that, so I was totally...

Dr. Emily Johnson: What?!

Lindsey Doherty: ...oblivious.

Dr. Emily Johnson: Oh my gosh.

Lindsey Doherty: Oh no...

Dr. Dawn Heiman: I think you need to at least watch the original, first episode of Survivor. [00:15:00] Richard won, by the way, if you watch it. Do you remember that?

Dr. Emily Johnson: Spoiler!

Lindsey Doherty: I do remember that.

Dr. Dawn Heiman: He lost so much weight. That was a crazy show.

That started all of this reality TV. Survivor. With Richard winning.

Yeah. Richard, if you're watching, we will take out your earwax. One time for free. One time, yes. Just to meet you.

Dr. Emily Johnson: So, as we wrap up in the next few minutes, DIY things to do at home. One of the common ones that we will recommend and often gets recommended by other providers is something called Debrox.

Debrox is a wax softener. And so if you already have globular, sticky wax, it's just gonna make your wax softer and stickier. It still has to come out. It doesn't just dissolve it. So if you've been using Debrox and you're still having wax issues, that's a reason to [00:16:00] come in and get evaluated. 'Cause you're just softening soft wax, and it still needs to be removed.

Dr. Emily Johnson: If you're somebody who makes rock-hard wax, where you tap on it and it's like tick, tick, tick, we can either soften it in office with something called Wax MD, which was my best friend last Thursday when I removed a rock-hard piece of wax that other providers had told her would not be able to be removed in office, but we were able to soften it with Wax MD and a dash of patience, and it came out.

We have some samples of those too, of Wax MD similar to Debrox, just to soften everything up. But the point is it still needs to be removed.

Dr. Emily Johnson: So if you're a hard wax person, we might give you some of those samples. I recommend that you pick something up from like a Walgreens or a CVS and use it for about a week before your appointment to make sure that your wax is softer, easier to remove for us, as well as more comfortable for [00:17:00] you.

Dr. Emily Johnson: One thing, do not try - it is not proven to do anything - is ear candling. Keep the flames away from your head and your hair and your furniture because there is no proven studies that show that wax candling actually removes anything from your ear, and it's just a fire hazard. We want everybody to be safe.

You only have to make that mistake once for you to not do it again. But even one time with fire is not, not worth it.

Dr. Dawn Heiman: No, but it feels like there was a suction effect. Come in, and we will find a schedule that works best for you.

The sweet spot for most people is every three months of having their ears cleaned if they are producing a lot of wax, but some people at six months, sometimes we'll see in a year. You know, it depends on what you're using, what you're wearing. We don't want a hearing emergency where things got clogged up.

Dr. Dawn Heiman: So you can even go to any Walgreens. Go to the ear care section, and they have [00:18:00] Murine, Debrox, their own hydrogen peroxide and mineral oil that's combined a certain way. We also recommend sometimes flushing your ears with the shower head, once a month. You hang on to the wall, obviously.

Dr. Emily Johnson: Mm-hmm. Eyes open!

Dr. Dawn Heiman: If you don't have a hole in your eardrum, you don't have surgically placed tubes, anything like that. Discuss with your provider what's best for you.

Dr. Emily Johnson: Yeah. Absolutely.

Lindsey Doherty: But the rule of thumb is also: 'nothing smaller than your elbow in your ear.'

Dr. Emily Johnson: Yes.

Dr. Dawn Heiman: Yeah. But now people are putting earbuds in, and that didn't exist back when my mom told me to do that. My son, football season should be wrapping up, and he'll need to come in and get his annual irrigation. Sometimes it's twice a year. He just missed it. So he's gonna be all plugged up, and he's young. It's not an age thing. It's just genetics, and it depends on what you need.

Dr. Emily Johnson: Absolutely. There's nothing wrong with it. Some wax is good wax, but it becomes a problem when it's excessive. If you're not sure what camp you [00:19:00] fall into of - a little bit of wax or a lot of bit of wax - come on in.

We'll take a look, and then we'll be able to come up with a custom plan to make sure that your ears are lubricated, and you get the natural benefits of what the wax is there for, but it is not causing negative problems with your hearing, your hearing aids, or just kind of that sticky feeling you sometimes get in your ears.

Dr. Dawn Heiman: Yep. And that's it.

Dr. Emily Johnson: Okay. Thanks so much for listening, and we hope that you learned something about your earwax today. Bye!

​[00:20:00]