Part 1: Ear Wax, A Natural Defense Mechanism.

Though many believe ear digging is a hygienic practice, it can unknowingly trigger a range of ear problems. In reality, ear wax (cerumen) serves unreplaceable functions, that is to lubricate, clean, and protect the ear canal. It provides moisture that prevents the ear canal from drying, preventing itchiness and skin cracking. The wax plays a major role in the ear’s self-cleansing mechanism by transporting migrating dead cells from epithelium of the ear canal and tympanic membrane outward, a process known as epithelial migration.

It also has protective properties due to its bactericidal components, the lysozyme, immunoglobulin A, and fatty acids.¹ As the ear canal is sometimes referred to as the ‘greenhouse of the human body’ due to its warm, dark, humid, and moist environment, it is an ideal culture medium for microbes, especially fungi.¹ Fortunately, besides trapping these microbes, the wax creates an acidic environment that discourages microbial growth. Its sticky consistency also acts as a natural barrier trapping dust, debris and tiny insects before they can reach the sensitive eardrum. These trapped materials are then gradually expelled from the ear through epithelial migration.

As Surah Al-Imran Ayat 191 beautifully reminds us:

“Those who remember Allah while standing, sitting, and lying on their sides, and reflect on the creation of the heavens and the earth, [saying], “Our Lord, You did not create this in vain; glory be to You! Then protect us from the punishment of the Fire.” Nothing is made without purpose, even in the function of ear wax.

            Therefore, interrupting its physiology, such as habitual ear digging can trigger cascading complications. Particularly, skin lining the ear canal has no subcutaneous tissue, making it thin and vulnerable. Minor trauma caused by instrument like a cotton buds, hair pin, keys or even toothpicks will directly involve the cartilage underneath the skin, potentially leading to perichondritis. If the infection involved the bony part, it could progress to a severe, debilitating, chronic infection known as malignant otitis externa which can spread to the bony structures of the skull base. In some cases, remnants of cotton buds left in the ear canal become a nidus for bacteria or fungal infection, both can coexist ad further complicate treatment. Trauma is not limited to the skin, cartilage and bony part of the ear canal, but there are cases of ear eardrum that has been perforated by ear digging.

The skin of the canal is richly supplied with nerves, irritation may provoke a cough reflex or even a vasovagal response by stimulating the vagus nerve.² So, remember, if you cough while digging your ear, it is the Arnold nerve that is being irritated, and fainting is possible.

 Using cotton buds often pushes the wax further deep in the canal, causing it to adhere to tympanic membrane and lead to impaction and morbidity. Complete wax occlusion of the ear canal can result in up to a 40 dB hearing loss, along with tinnitus and cough.¹

         Alhamdulillah, ear care is free and effortless. Therefore, it is unreasonable to claim that using a cotton bud relieves ear itchiness, in fact it often causes it. Ear wax exists for vital reasons. Next time your ear itches, think wisely. Skip the ear digging, your ears will thank you.  

References:

1. Roeser RJ, Balachanda BP. Physiology, pathophysiology, and anthropology/ epidemiology of human ear canal secretions. J Am Acad Audiol 1997; 8(5): 391–400. 

2. Watkinson JC, Clarke RW, editors. Scott-Brown’s Otorhinolaryngology and Head and Neck Surgery. Vol. 2. 8th ed. Boca Raton: CRC Press; 2018. 

https://doi.org/10.120/9780429443558.  

                                                                                     Photo By Nor Shahida's clinical picture collection.
                  Figure 2: Otoendoscopic image showing ear hair and ear wax on the tympanic membrane, with visible signs of trauma at the superior                                                                                                                 quadrant, likely resulting from cotton bud-induced ear digging..

                                                                               Photo By Nor Shahida's clinical picture collection. 

                                                            Figure 3: Otoendoscopic image showing tympanic membrane perforation with

                                                            signs of acute infection in a patient with a history of chronic cotton bud use.