Ear Wax

Overview

Ear wax (the medical word is cerumen, say 'seh-ROO-men') is a natural, slightly sticky substance made by small glands in the outer part of your ear canal. It is not dirt. It helps protect the skin inside your ear, keeps it slightly oily, and traps dust and tiny bits of grit so they do not travel deeper. Most of the time, wax slowly moves outward on its own, helped by chewing and by the movement of your jaw, and it falls out without you noticing.

Very common. Blocked ears from wax are one of the most frequent ear problems seen in general practice, and pharmacists answer questions about them every day.

Anyone can get blocked ears from wax, at any age. It is more likely if you are older, wear hearing aids or earplugs, have narrow or bendy ear canals, work in dusty places, or clean your ears with cotton buds. Some people simply make more wax, or wax that is drier and harder, than others.

Symptoms

Common symptoms

• A feeling of fullness or blockage in the ear, like there is something in it
• Hearing that sounds muffled or turned down, often in one ear
• Mild discomfort, aching or itching in the ear
• Ringing or buzzing in the ear (tinnitus)
• A feeling of dizziness or unsteadiness, though this is less common
• A dry cough that appears when wax presses on the wall of the ear canal

Symptoms in children

• Rubbing, tugging or poking at the ear
• Not turning towards sounds, or seeming to hear you less well
• Being unsettled, clingy or irritable for no clear reason
• Turning the TV or tablet volume up higher than usual
• Teachers noticing your child is not following instructions or seems 'away with the clouds'
• Speech sounds that are unclear, or slow language development
• Wax is often found during a routine hearing check rather than being noticed at home

Symptoms in older adults

• More wax build-up, because wax becomes drier and harder with age
• Hearing loss that gets blamed on ageing when wax is part of the cause
• Wax pushed deeper and packed down by hearing aids or earmoulds
• More need for professional wax removal, sometimes regularly
• Feeling left out of conversations, or turning the TV up loud
• Reduced hearing can add to tiredness and confusion, especially in busy places

Causes

Main causes

• Your body naturally makes more wax, or makes wax that is thicker or drier than usual
• Pushing wax deeper with cotton buds, fingers, earplugs or earbuds
• A narrow, bendy or hairy ear canal that makes it harder for wax to travel out
• Getting older, which changes the texture of wax so it clears less easily
• Water getting into the ear, for example when swimming, which makes wax swell and block the canal
• Skin conditions such as eczema in the ear canal, which can cause extra wax and flaky skin
• Hearing aids and earmoulds, which can act like a plug and trap wax

Risk factors

• Using cotton buds or other objects to clean your ears
• Wearing hearing aids, earplugs or in-ear headphones regularly
• Being over 60
• Working or spending time in dusty or dirty environments
• A history of ear infections or eczema in the ear
• Having had blocked ears before, or needing wax removal in the past
• Swimming often

When to see a doctor

See a doctor urgently if:

• You notice sudden hearing loss, or your hearing drops quickly
• You have ear pain that is getting worse, or pain with a fever
• There is fluid, pus or blood coming from your ear
• Your child has a blocked ear and a fever, or is clearly unwell
• You feel very dizzy, are vomiting, or are unsteady on your feet
• You have any weakness or drooping on one side of your face

Book a routine appointment if:

• Muffled hearing has not improved after 5 to 7 days of softening drops from your pharmacist
• Wax keeps blocking your ears, even after it has been removed before
• You need your ears checked before being fitted with a hearing aid or earmoulds
• You have ongoing itch or discomfort in your ear
• Your child seems to be hearing less well, or is falling behind at school with listening
• You have tried home care and feel unsure what to do next

Diagnosis

A doctor, nurse or pharmacist will ask about your symptoms and then look inside your ear with a small hand-held light called an otoscope (say 'OH-toh-skope'). They can see straight away whether wax is blocking the canal. This takes just a couple of minutes and does not hurt.

Tests that may be done

• Otoscopy: looking into the ear with a small light to see the wax
• Checking your hearing with simple questions, or a whisper or tuning fork test
• A hearing test (audiometry) if the cause of your hearing loss is not clear
• A tympanometry test, which checks how the eardrum moves, if an infection or fluid is suspected
• Referral to an ear, nose and throat (ENT) specialist if problems keep coming back

What to expect at your appointment

The check is quick and painless. The clinician may gently straighten your ear canal by pulling the ear slightly, which can feel odd but should not hurt. If wax is the cause, they will usually suggest softening drops first, or offer to remove the wax there and then if the right equipment is available. You can ask them to show you what they see.

Treatment

Most blocked ears get better at home with softening ear drops and a little patience. If drops do not work after about a week, a trained nurse, audiologist or ear care specialist can remove the wax gently. Treatment is simple, safe and usually works well.

Self-care at home

• Ask your pharmacist about ear drops that soften wax, and follow the instructions on the packet for around 3 to 5 days.
• Give it time. Softened wax often clears on its own within one to two weeks.
• Warm olive or almond oil drops are a traditional option your pharmacist can advise on, especially if you have skin sensitivity.
• Lie on your side with the blocked ear facing up for a few minutes after putting in drops, so they can soak in.
• Don't put cotton buds, hairpins, matchsticks or any other object into your ear canal. This is the most common cause of problems.
• Keep your ears dry. After swimming or washing, tilt your head to let water run out and pat the outside of your ear with a towel.
• If drops make your hearing worse, or cause pain, itching or soreness, stop using them and speak to your pharmacist or doctor.
• Avoid ear candles. They are not recommended and can cause burns, injury and wax being pushed deeper.

Medical treatments

A healthcare professional can remove wax in a few different ways. Ear irrigation uses gentle, warm water to wash the wax out; softening drops are usually used for several days beforehand. Microsuction uses a tiny gentle vacuum to lift the wax out under a bright light and a magnifier, and is often the preferred method. Sometimes a clinician uses a small instrument called a probe or a tiny hook. All of these are quick, usually painless, and can be done in a clinic. Your clinician will explain which option suits your ears and any risks, and will check your hearing afterwards.

When is surgery considered?

Surgery for ear wax is very rarely needed. It may be considered only if you have a very narrow or damaged ear canal, repeated severe problems, or another ear condition that needs an operation. Your ear, nose and throat specialist would discuss this with you in detail.

Living with this condition

A blocked ear can be annoying, especially when it makes conversations, the TV or background noise harder to follow. Simple habits help: keep softening drops at home if you are prone to wax build-up, ask people to face you when they speak, and avoid noisy places where you have to strain to hear. If you wear hearing aids, have your ears checked regularly, because wax can block the aid and make it seem like the aid is not working.

Lifestyle tips

• Skip cotton buds completely. Wipe only the outside of your ear with a cloth.
• If you swim often, ask your pharmacist about ways to keep water out of your ears.
• Take short breaks from in-ear headphones, and keep the volume at a comfortable level.
• Have your ears checked before and after being fitted for hearing aids or earmoulds.
• If you work in a dusty place, use the ear protection your employer provides.
• Keep any follow-up appointments, especially if wax has blocked your ears before.

Diet and exercise

What you eat and how much you exercise do not directly change how much wax your ears make. But staying generally healthy helps you cope with the frustration of poor hearing. If you have hearing loss, staying active and social is good for your mood and your thinking. If you have a skin condition like eczema that affects your ears, your doctor may talk to you about general skin care.

Mental health and emotional wellbeing

Even a small amount of hearing loss can be tiring and upsetting. You may find yourself avoiding group conversations, nodding along without following, or feeling left out. That is very common and nothing to be ashamed of. It usually improves quickly once the wax is cleared. If low mood or worry is affecting your daily life, please talk to your doctor. If you ever feel you cannot cope, contact your local crisis support service or emergency number straight away.

Prevention

You cannot stop your ears making wax, and you would not want to, because it protects your ear canal. But you can greatly reduce the chance of wax causing a blockage. The single most helpful thing is to never put cotton buds or other objects into your ear canal. If you are prone to blocked ears, your pharmacist can advise on using softening drops now and then, and on having your ears checked regularly by a nurse.

Screening programmes

There is no routine screening programme for ear wax. If you wear hearing aids, have regular ear checks as part of your hearing care. If you notice your hearing getting worse, ask for a hearing test rather than assuming it is just wax.

Complications

If left untreated

• Hearing that stays muffled or gets gradually worse
• Ringing or buzzing in the ear (tinnitus)
• A sore, itchy or swollen ear canal, sometimes called swimmer's ear
• An outer ear infection, which may need treatment from your doctor
• Hearing aids that stop working well or whistle because wax is blocking them
• Feeling isolated or left out because it is hard to follow conversations
• Scratches or damage to the ear canal or eardrum from trying to remove wax yourself
• A persistent dry cough caused by wax pressing on the ear canal wall

Long-term outlook

The outlook is very good. Ear wax is a normal part of a healthy ear, and blocked ears usually clear with simple softening drops or a short visit for professional removal. Most people hear normally again straight afterwards. If your ears block up again, you will know what to do next time, and your pharmacist or nurse can help you make a simple plan.

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