Ear Wax Impaction

What ear wax impaction is

Ear wax is a mix of oily secretions from glands in the outer third of the ear canal, dead skin cells and hair. It is not dirt. It traps dust, repels water, keeps the canal moist and has mild antibacterial properties.

The ear cleans itself. Skin in the ear canal grows outward from the eardrum, like a slow conveyor belt, carrying wax with it. Jaw movement from talking and chewing helps. The wax reaches the opening, dries and falls out. Doctors call wax impacted when it builds up and causes symptoms or stops them seeing the eardrum. Having wax in your ear without symptoms is normal and needs no treatment.

Two types of ear wax

Both types can impact. Wax also becomes harder and drier with age, which is one reason older adults are affected more often.

Symptoms of impacted ear wax

• Muffled or reduced hearing in one or both ears. Wax causes a conductive hearing loss because sound cannot reach the eardrum. It often appears suddenly after showering or swimming, when water makes the wax swell and seal the canal.
• A full, blocked or plugged feeling in the ear. See plugged feeling in the ear.
• Ringing or buzzing (tinnitus).
• Itching inside the ear.
• Mild ear ache or discomfort.
• Dizziness or a spinning sensation, sometimes, if the wax presses on the eardrum.
• A cough, occasionally, because a branch of the vagus nerve supplies the ear canal.
• Hearing aid whistling or poor sound because wax blocks the earpiece.

In young children, people with dementia and people with learning disabilities, impaction may show up only as poorer hearing, inattention or changes in behavior.

Causes and risk factors

What pushes wax deeper

• Cotton swabs, hairpins, keys or fingers act like a plunger and pack wax against the eardrum. This is the commonest preventable cause.
• Earbuds, earplugs and hearing aids block the natural outward flow and push wax inward.

What makes wax build up

• Older age: wax is drier and the self-cleaning movement slows.
• Narrow, curved or hairy ear canals, and bony growths in the canal (exostoses or "surfer's ear") from repeated cold-water exposure.
• Skin conditions such as eczema or psoriasis in the ear canal.
• Overproduction of wax, which varies between people.
• Intellectual disability and dementia, partly because symptoms go unreported.

How it is diagnosed

A doctor, nurse or audiologist looks into the ear with an otoscope (a lighted magnifier). Impaction is diagnosed when wax blocks the canal and causes symptoms or prevents an eardrum exam. They will ask about previous ear surgery, a hole in the eardrum, diabetes, a weakened immune system and blood thinners, because these affect which removal method is safe.

If hearing does not return to normal after the wax is cleared, a hearing test is the next step. Wax can hide a second problem such as hearing loss from age or noise, fluid behind the eardrum, or an infection.

Treatment: how to remove impacted ear wax

Guidelines from the American Academy of Otolaryngology recommend treating impaction only when it causes symptoms or blocks an exam. There are three main approaches, used alone or in combination.

1. Ear drops (cerumenolytics)

Drops soften and loosen wax so it can work its way out. Options include:

• Olive oil or almond oil: 2 to 3 drops, 2 to 3 times a day.
• Sodium bicarbonate drops.
• Carbamide peroxide drops (sold as ear wax removal kits). These fizz as they release oxygen.
• Saline or plain water, which work about as well as many commercial products.

Lie with the affected ear up, put in the drops, and stay still for 5 minutes. Use for 3 to 5 days, and up to 2 weeks if needed. Hearing can feel worse for a day or two as the wax swells. Do not use drops if you have a hole in your eardrum, grommets, or ear pain with discharge.

2. Irrigation

Warm water (at body temperature, to avoid dizziness) is squirted into the canal to flush the softened wax out. A clinic uses an electronic irrigator with controlled pressure. Home bulb syringe kits are available. Using drops for a few days first makes irrigation more successful.

Irrigation is not suitable if you have a perforated eardrum, previous ear surgery, grommets, an ear infection, diabetes or a weakened immune system (because of the risk of malignant otitis externa), or if you have had problems with it before.

3. Manual removal

An ENT specialist, audiologist or trained nurse removes the wax under direct vision using:

• Microsuction: a tiny suction tube under a microscope or headlight. It is quick, dry and safe for people who cannot have irrigation.
• A curette or hook: a small instrument that lifts out hard wax.
• Forceps for loose pieces.

Removal options compared

What not to do

• Do not use cotton swabs inside the canal. They push wax deeper and can scratch the canal or perforate the eardrum.
• Do not use ear candles. They do not create suction or remove wax. They can burn the face, ear canal and eardrum and leave candle wax in the ear.
• Do not use sharp objects, oral jet irrigators (dental water flossers) or high-pressure devices.

Complications

Complications are uncommon but include:

• infection of the ear canal (otitis externa), especially after irrigation
• a hole in the eardrum (tympanic membrane perforation)
• scratches and bleeding from the canal
• temporary dizziness or ringing during removal

Prevention

• Clean only the outer ear with a washcloth. Leave the canal alone.
• If you are prone to impaction, use olive oil drops or a wax-softening product once a week, or have routine cleaning every 6 to 12 months.
• Hearing aid users should have their ears checked every 3 to 6 months.
• Swimmers and surfers can wear earplugs to reduce bony growths in the canal.

Frequently asked questions

What are the symptoms of impacted ear wax?

The main symptoms are muffled hearing, a full or plugged feeling, ringing (tinnitus), itching and mild ear ache. Some people also feel dizzy or develop a cough. Symptoms often appear suddenly after a shower or swim, when water makes the wax swell and seal the ear canal.

How do you remove impacted ear wax at home?

Use olive oil, almond oil, sodium bicarbonate or carbamide peroxide drops 2 to 3 times a day for 3 to 5 days. Lie with the ear up for 5 minutes after each dose. Gentle irrigation with a bulb syringe may help after that. Do not do this if you have a perforated eardrum, grommets or ear surgery.

Can impacted ear wax cause dizziness?

Yes, sometimes. Wax pressing on the eardrum can cause mild dizziness, and so can cold water during irrigation. Severe spinning, dizziness with hearing loss that does not improve, or dizziness with other neurological symptoms needs medical assessment rather than wax treatment.

How long does it take for impacted ear wax to clear?

With drops, most softened wax works its way out within 3 to 7 days, though hard wax may take up to 2 weeks. If symptoms persist after 5 days of drops, see a clinician for irrigation or microsuction, which usually clears the canal in a single visit.

Is ear wax impaction dangerous?

It is not dangerous in itself, and hearing returns once the wax is removed. Problems mainly come from unsafe removal: cotton swabs, ear candles or sharp objects can cause infection or a perforated eardrum. In older adults, untreated impaction worsens hearing and communication.

Should I see a doctor for ear wax?

See a doctor or nurse if drops do not work after 5 days, if you have pain, discharge, bleeding or sudden hearing loss, or if you have a history of eardrum perforation, ear surgery, diabetes or a weak immune system. They can remove wax safely under direct vision.