I have had many patients who are concerned about the cleanliness of their ears when I perform a visual inspection of the outer ear canal (otoscopy). Cerumen in small amounts is perfectly normal. Cerumen provides a defense against insects that might wander in, has a pH factor that is not conducive to the growth of bacteria or other microbes, and helps keep the outer ear canal moist. The ear actually sloughs off debris through a process called migration. Dead skin cells coupled with cerumen travel at very slow speeds from the inside of the canal toward the lateral (outside) portion of the canal. Some individuals produce more cerumen than the system can handle and as a result there is a buildup. Normally this does not affect hearing, until the ear canal is nearly or fully occluded. Removal in most cases is fairly straightforward. An audiologist or ENT specialist (physician) is trained to remove cerumen. This is an outpatient procedure and can usually be performed in a few minutes. Sometimes the removal is a little more involved and may require the use of ear drops (cerumenolytics) that soften the wax and make it easier to remove. In some instances a small curette will be used to extract the cerumen, while for other cases an irrigation will be performed where a stream of water is directed into the outer ear canal, eventually resulting in the removal of the debris. While this type of approach can be disconcerting to a patient who has never undergone through this procedure, it is normally well tolerated.