Cerumen Impaction (Earwax Blockage)

What earwax does

Earwax is a natural mix of secretions from glands in the outer ear canal, shed skin and hair. It protects the ear by trapping dust and germs, moisturizing the canal and repelling water. Jaw movements from chewing and talking gradually move wax outward, where it dries and falls out. The ear canal is self-cleaning, so most people never need to remove wax.

Causes of cerumen impaction

• Cotton swabs, fingers, hairpins and other objects: push wax deeper and pack it against the eardrum
• Hearing aids and earplugs: block natural wax migration
• Narrow, curved or hairy ear canals
• Older age: wax becomes drier and harder, and canal hairs thicken
• Excessive wax production
• Skin conditions such as eczema of the ear canal
• Intellectual disability: for reasons that are not fully understood

Symptoms

• muffled or reduced hearing, usually in one ear
• a feeling of fullness or a plugged ear
• tinnitus (ringing or buzzing)
• itching
• earache
• dizziness or a spinning sensation
• a chronic cough, from stimulation of a nerve in the ear canal
• whistling (feedback) from hearing aids

Many people with wax in the ear canal have no symptoms. Wax only needs treatment if it causes symptoms or blocks the doctor's view of the eardrum.

Diagnosis

A doctor, nurse or audiologist looks into the ear with an otoscope. Impaction is diagnosed when wax blocks the view of the eardrum or is associated with symptoms. They will ask about previous ear surgery, a perforated eardrum, ear infections, diabetes and blood thinners, which affect the choice of removal method. A hearing test may be done after removal if hearing does not return to normal.

Treatment

Ear drops (cerumenolytics)

Softening drops are often the first step and can be used at home:

• olive oil or almond oil
• sodium bicarbonate drops
• carbamide peroxide or hydrogen peroxide drops
• plain water or saline, which work about as well as many commercial drops

Lie with the affected ear up, put in the drops as directed on the label, and stay lying down for a few minutes. Use them for 3 to 5 days, or as the label directs. Wax may come out on its own, or the ear may then be ready for irrigation.

Do not use drops if you have a hole in your eardrum, ear tubes, or current ear pain or discharge.

Irrigation

Body-temperature water is gently flushed into the ear canal, often after a few days of drops. A clinician can do this with an irrigator, and home bulb syringes are available. Irrigation is avoided with:

• a known or suspected perforated eardrum or ear tubes
• previous ear surgery
• current ear infection
• diabetes or a weakened immune system (higher risk of serious outer ear infection)
• only one hearing ear (because of a small risk of damage)

Microsuction and manual removal

An ENT specialist, audiologist or trained nurse uses a microscope or headlamp and a small suction device, curette, hook or forceps to remove wax directly. This is the method of choice when irrigation is not suitable and is usually quick and comfortable.

What not to do

• Do not use cotton swabs inside the ear canal. They push wax in and can scratch the canal or puncture the eardrum.
• Do not use ear candles. They do not remove wax and can cause burns, blockage with candle wax, and eardrum perforation.
• Do not use sharp objects such as keys or hairpins.
• Do not use jet water sprayers designed for teeth.

Complications

Of the impaction:

• temporary conductive hearing loss
• outer ear infection

Of removal (uncommon):

• scratches or bleeding in the canal
• eardrum perforation
• dizziness during irrigation
• outer ear infection

Prevention

• Clean only the outer ear with a washcloth.
• If you are prone to impaction, use softening drops or a few drops of olive oil once a week, or have regular clinic cleaning every 6 to 12 months.
• Hearing aid users should have their ears checked for wax regularly.

Frequently asked questions

What is cerumen impaction?

Cerumen impaction is earwax that has built up and blocked the ear canal or is causing symptoms such as muffled hearing, fullness, ringing, earache or dizziness. It is common, especially in older adults and people who use cotton swabs, hearing aids or earplugs.

How do you remove impacted earwax at home?

Use softening drops such as olive oil or over-the-counter wax drops for 3 to 5 days, following the label. A bulb syringe with warm water can then gently flush the ear if you have no history of eardrum perforation, ear surgery or diabetes. If symptoms persist, see a clinician.

Can impacted earwax cause dizziness?

Yes. Earwax pressing against the eardrum can occasionally cause dizziness, a feeling of imbalance, or a cough. Dizziness with vomiting, severe imbalance or sudden hearing loss should be checked by a doctor promptly.

Are ear candles safe for earwax removal?

No. Studies show ear candles do not create suction or remove wax. They can cause burns to the face and ear, block the ear canal with candle wax and puncture the eardrum. Health authorities advise against using them.

How often should earwax be removed?

Only when it causes symptoms. Most people never need wax removed because ears clean themselves. People who repeatedly develop impaction, or who wear hearing aids, may benefit from regular softening drops or clinic cleaning every 6 to 12 months.