Zhang S, et al. - In the present study, the researchers studied the exact composition and attempted to be helpful in explaining the etiologic mechanism of cerumen impaction in the external auditory canal (EAC). A hundred impacted samples of cerumen and 15 normal samples of cerumen were obtained by manual extraction and divided into two categories. In group 1, 88 patients were in the habit of using cotton buds. It was noted that 47 impacted cerumen samples tested positive for microbes, whereas only 1 sample of normal cerumen tested positive for microbes. Staphylococcus aureus and Aspergillus terreus, respectively, were the most commonly isolated bacterium and fungus. Impacted cerumen consists of abnormal exfoliated keratinocytes associated with neutrophil-mediated inflammation caused by microbial inducements. Mold infection was highly associated with recurrent cerumen impaction. It was strongly recommended microbial culture of removed impacted cerumen. Ear cleaning with cotton buds, especially when the EAC is wet, maybe one of the major causes of cerumen impaction that needs to be studied further.