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Health condition

Earwax blockage, softening drops, safe removal and when to choose microsuction.

Wax is normal and protective. When it impacts, a stepped approach clears symptoms without harming the canal or the drum.

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Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against NICE NG98, ENT UK and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including ceruminolytics, electronic irrigation and microsuction.

Key facts

Earwax blockage at a glance.

The essentials, in plain English - what wax does, why it impacts, and how it is safely cleared in the UK today.

  • What it is

    Impacted cerumen - a build-up of earwax that fills the canal, dulls hearing and can cause pressure, itching or tinnitus.

  • Wax is protective

    Cerumen is antimicrobial and traps dust and debris. The ear is self-cleaning - most people never need to remove it.

  • How common

    Up to 5% of adults, 10% of children, 30% of older adults and 60% of people with learning disabilities are affected.

  • Common triggers

    Cotton buds, hearing aids or earplugs, narrow canals, drier wax with age, ear hair, eczema or previous ear surgery.

  • First-line at home

    Olive oil, sodium bicarbonate or sodium docusate drops for 3 to 5 days - alone this settles many mild cases.

  • Procedures

    Electronic irrigation, microsuction or manual removal - chosen based on ear anatomy, history and safety.

Why this guide matters

Safe removal, not self-cleaning.

Most ear problems patients call wax are made worse by the tools they reach for. The three points below shape the rest of this guide.

  • Cotton buds cause impaction

    They push wax deeper, tear the canal skin and set up otitis externa. If your ear feels blocked, drops and a clinician - not a bud.

  • Soften before you remove

    Olive oil, sodium bicarbonate 5% or sodium docusate for 3 to 5 days makes irrigation or microsuction quicker, gentler and safer.

  • Microsuction is the gold standard

    A microscope and fine suction allows wax to be cleared safely - including in ears with perforations, grommets or previous surgery.

How the diagnosis is made

From a blocked ear to a clear plan.

The steps a UK GP, audiologist or ENT surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and symptoms

    Duration, hearing loss, tinnitus, dizziness, pain and any previous ear surgery, grommets or perforations.

  2. 02

    Assessing

    Otoscopy

    Direct look into the canal to confirm wax, gauge how impacted it is and check the eardrum where visible.

  3. 03

    Assessing

    Tuning fork tests

    Rinne and Weber tests distinguish a conductive picture (typical of wax) from a sensorineural cause.

  4. 04

    Confirming

    Rule out other pathology

    Exclude foreign body, otitis externa, cholesteatoma and a hidden tympanic perforation before choosing a removal method.

  5. 05

    Confirming

    Audiometry if hearing concerns

    A pure-tone audiogram after clearance confirms hearing has returned to baseline or flags a separate hearing loss.

  6. 07

    Preparing

    Specialist ENT if needed

    Refractory wax, complications, a suspected perforation, a mastoid cavity or an only-hearing ear needs ENT input.

Typical timeline: softening for a few days, then a single appointment to clear the wax.

Symptoms

What earwax blockage feels like.

Muffled hearing, fullness and tinnitus lead the picture - but a reflex cough or dizziness point to the same cause.

  • Reduced hearing

    The most common symptom - a conductive, muffled hearing loss that often clears completely after removal.

  • Fullness or blockage

    A sense of pressure or a plugged ear, often worse after showering, swimming or using earplugs.

  • Tinnitus

    Ringing, buzzing or humming - frequently improves once the canal is cleared.

  • Otalgia and itching

    Dull ache or an itchy canal - from pressure on the canal wall or from associated dermatitis.

  • Dizziness

    Occasional mild vertigo, particularly with cold or warm water in the canal - the caloric effect.

  • Reflex cough

    Coughing when the canal is touched - the Arnold nerve reflex, a classic sign of wax pressing on the canal wall.

  • Voice changes

    Own voice sounds louder or hollow - autophony from a blocked canal altering how sound is transmitted.

  • Red flag - discharge or severe pain

    Persistent discharge, severe pain or sudden hearing loss suggests infection or perforation - not just wax.

Treatment

How earwax blockage is treated in the UK.

Softening drops first.

  • Observation

    Asymptomatic wax rarely needs removal. The ear is self-cleaning - leave well alone unless it is causing symptoms.

  • Ceruminolytic drops

    Olive oil, sodium bicarbonate 5% or sodium docusate for 3 to 5 days - softens wax before any procedure and often clears it alone.

  • Electronic ear irrigation

    A controlled-pressure irrigator (Propulse or ProPulse-style device) in primary care - NICE NG98 approved when there is no contraindication.

  • Aural microsuction

    Gold-standard removal with a microscope and fine suction - safe with perforations, grommets or previous surgery. See our microsuction guide.

  • Manual removal

    A Jobson Horne probe or fine curette used by ENT or a trained audiologist - useful for firm wax near the drum.

  • Avoid cotton buds

    They push wax deeper, damage the canal skin and increase the risk of otitis externa. Never insert anything smaller than an elbow.

  • Avoid ear candles

    No evidence of benefit and clear risk of burns, canal obstruction and wax residue - not recommended by any UK society.

  • Hearing aid users

    Regular microsuction and hearing aid cleaning through specialist audiology - hearing aids trap wax and worsen impaction.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, audiologist or ENT surgeon knows your ears and history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Hearing loss in adults: assessment and management (NG98).

  • NICE Clinical Knowledge Summary. Earwax.

  • ENT UK. Position statement on ear wax removal and microsuction.

  • British Society of Audiology. Practice guidance on cerumen management.

Red flags

When it is not just wax.

Most impacted wax is dealt with quickly and safely. These situations are different - and where a specialist opinion is needed.

  • Sudden hearing loss

    Sudden sensorineural hearing loss is an emergency - not simply wax. Same-day ENT assessment is needed to preserve hearing.

  • Severe otalgia or discharge

    Persistent pain, offensive discharge or blood suggests otitis externa, otitis media or perforation - not wax alone.

  • Known or suspected perforation

    Do not irrigate. Choose microsuction and involve ENT - impacted wax can hide an underlying perforation.

  • Previous grommets or ear surgery

    Any history of grommets, tympanoplasty, mastoidectomy or a mastoid cavity is a contraindication to irrigation.

  • Only-hearing ear

    Extra caution in the only-hearing ear - specialist ENT or audiology microsuction rather than primary care irrigation.

  • Facial nerve or balance symptoms

    Facial weakness, severe vertigo or asymmetric neurological signs need urgent ENT and neurology input.

  • Suspected cholesteatoma

    A pearly white mass, chronic discharge or a retraction pocket needs prompt ENT referral - not repeat wax removal.

  • Suspected canal tumour

    A friable, bleeding or unusually firm lesion in the canal warrants ENT review with imaging.

  • Children and learning disability

    Higher rates of impaction and a lower tolerance for procedures - plan removal with an experienced clinician.

Living with it

A treatable problem, with a clear plan.

Four things that make the biggest difference day to day - leaving the canal alone, softening if you impact easily, staying on top of hearing aid hygiene and escalating early.

A quiet reminder

Nothing smaller than an elbow.

The single best rule for healthy ears - keep cotton buds, hairpins and picks out of the canal entirely.

  1. 01 Prevention

    Leave the canal alone

    Do not insert cotton buds, hairpins or ear picks. The ear cleans itself - anything smaller than an elbow does not belong in it.

  2. 02 Softening

    Regular olive oil if prone

    A few drops of olive oil once or twice a week keeps wax soft and moving in people who impact easily.

  3. 03 Hearing

    Book microsuction if you wear aids

    Hearing aid users should have a wax check and microsuction on a regular schedule, not just when hearing drops.

  4. 04 Escalate

    See ENT if it keeps coming back

    Refractory impaction, complications or persistent symptoms after removal warrant a specialist ENT review.

Frequently asked

Everything we get asked about earwax.

Quick answers on drops, cotton buds, ear candles, irrigation and microsuction.

  • What is earwax blockage?

    Earwax blockage, or impacted cerumen, is a build-up of wax that fills part or all of the ear canal. It can dull hearing, cause a plugged sensation, ringing, itching or a mild ache, and sometimes triggers a reflex cough or dizziness. Wax itself is normal and protective - it becomes a problem only when it impacts.

  • Why should I avoid cotton buds?

    Cotton buds push wax deeper into the canal, damage the delicate canal skin and can trigger otitis externa. Most cases of impaction involve regular cotton bud use. If your ears feel blocked, use olive oil drops and see a clinician rather than a cotton bud.

  • Are ear candles safe?

    No. Ear candling has no evidence of benefit and a clear risk of burns, canal obstruction with candle wax, and eardrum damage. It is not recommended by any UK ENT or audiology society.

  • What is the difference between irrigation and microsuction?

    Irrigation uses controlled-pressure warm water from an electronic irrigator to flush wax out. Microsuction uses a microscope and a fine suction tube to lift wax out under direct vision. Microsuction is safer where there is a perforation, grommet, previous ear surgery, mastoid cavity, otitis externa or an only-hearing ear.

  • Do I need to soften the wax first?

    Yes, in most cases. Olive oil, sodium bicarbonate 5% or sodium docusate drops for 3 to 5 days before a procedure make removal quicker, gentler and more likely to succeed. NICE advises against using hydrogen peroxide and water alone.

  • When should I see ENT rather than my GP or audiologist?

    Refractory wax, complications after removal, persistent symptoms, sudden hearing loss, severe pain, discharge, dizziness, a suspected cholesteatoma or an only-hearing ear should all be reviewed by ENT rather than repeated in primary care.

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