Cerumen impaction (earwax blockage): symptoms, safe removal and when to see someone

NICE Clinical Knowledge Summaries describes earwax as a normal substance made of dead flattened cells, cerumen and sebum. It cleans, lubricates and protects the lining of the ear canal, traps dirt, dust and hair, repels water, and is acidic, which inhibits the growth of bacteria and fungi. Normally it leaves the canal spontaneously through natural jaw movement. If that natural mechanism is disrupted or inadequate, wax is retained and may become impacted.

The NHS makes the same basic point in plain language: earwax normally falls out on its own, and it is only a problem when it builds up and blocks your ears.

The NHS lists the symptoms of earwax build-up as:

• hearing loss

• earache or a feeling that the ears are blocked

• ringing or buzzing in the ears (tinnitus)

• vertigo (feeling dizzy and sick)

The NHS says build-up can happen if you have narrow or damaged ear canals, lots of hair in the ear canals, a skin condition affecting the scalp or the area around the ear, or inflammation of the ear canal (otitis externa, or swimmer's ear). It says you cannot prevent earwax, because it is there to protect your ears from dirt and germs, but regularly using ear drops or olive or almond oil will help soften wax so that it falls out on its own and should stop ears becoming blocked.

The NHS is firm that using fingers or objects such as cotton buds to remove earwax pushes it in and makes things worse.

The NHS describes a method: lie on your side with the affected ear facing up, put 2 to 3 drops of olive or almond oil in the ear (not almond oil if you are allergic to almonds), stay on your side for 5 to 10 minutes, and repeat 3 to 4 times a day for 3 to 5 days. Over about 2 weeks, lumps of wax should fall out and symptoms should improve. The NHS says there is no evidence that ear candles or ear vacuums get rid of earwax.

A pharmacist can give advice and suggest treatments, which might include medicines to dissolve wax; the NHS says the wax should fall out or dissolve after about a week. Do not use drops if you have a hole in the eardrum (perforated eardrum). NICE CKS likewise advises drops for 3 to 5 days initially to soften wax and says they should not be prescribed if a perforated eardrum is suspected.

The NHS advises seeing a nurse at your GP surgery if symptoms have not cleared after 5 days, or if the ear is badly blocked and you cannot hear anything, because you could get an infection if it has not cleared. It notes that not all GP surgeries remove earwax; some flush the wax out with water (electronic ear irrigation), suck it out (microsuction) or scrape it out with a very small device, and these treatments are usually painless. If your surgery does not offer this, a doctor might refer you to another local NHS service, or you might have to pay to have it done privately.

NICE CKS says wax should be removed if it is blocking the canal and the person has symptoms, if the eardrum needs to be seen to make a diagnosis, or if the person wears a hearing aid and wax needs clearing for a mould or because it makes the hearing aid whistle. Irrigation can be considered if drops fail and there are no contraindications, and microsuction may be considered if the equipment and expertise are available.

NICE CKS advises referral to an ear, nose and throat specialist if there is pathology of the ear canal or eardrum, a foreign body in the canal, unsuccessful drops where irrigation is not suitable and microsuction is not available, unsuccessful irrigation after two attempts, multiple ineffective attempts at removal, or symptoms that persist after the wax has been cleared. It advises seeking urgent specialist advice if severe pain, deafness or vertigo occur during or after irrigation or a perforation is seen afterwards, or if there is infection and the canal needs clearing of wax, debris and discharge.

Hearing loss that continues after wax has been removed deserves a hearing assessment rather than an assumption that wax was the only cause.