Earwax build-up and removal | Pī taringa

Key points about earwax build-up and removal

  • Earwax (pī taringa) is naturally produced by your body to protect the inside of your ear from dust and infection.
  • Earwax is normal and if it's not causing any problems should be left alone.
  • Usually, earwax moves slowly from the inside to the outside of your ear, where it falls out, but sometimes it builds up and forms a plug that blocks your ear.
  • Earwax plugs often fall out by themselves, but may need to be removed by a healthcare provider.
  • Using cotton wool buds or ear candles doesn't work and isn't safe.
Older woman cupping her left ear with hearing loss
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Earwax is a waxy secretion made by your ear canal. It helps to clean your ear and prevent infections. It does this by being sticky and trapping dust. The muscles of your jaw help the wax to move out of your ear. Earwax is usually yellow or brown in Caucasians and flakier and grey in Asians and Pacific Peoples.

The image below shows earwax coming out of a child's ear naturally. 

Earwax naturally coming out a child's ear

Image credit:Depositphotos

Some people naturally make a lot of earwax, or make hard and dry wax that's more likely to build-up. Other things affecting wax build-up include:

  • hearing aids, ear plugs and ear buds
  • having hairy or narrow ear canals 
  • being an older adult, because the skin of your ear canal gets drier
  • bony growths in the outer part of your ear canal
  • working in dusty environments
  • radiotherapy or skin conditions
  • putting things into your ear canal, like cotton buds or fingers – this stops the self-cleaning process and pushes wax back down your ear canal.

The build-up of ear wax in your ear can cause:

  • discomfort, itching or pain in your ear
  • a feeling of fullness or a blocked feeling in your ear
  • hearing problems, eg, mild deafness
  • ringing, humming or buzzing in your ear (tinnitus)
  • dizziness (vertigo).

These can happen in 1 or both of your ears.

The build up of earwax is diagnosed by examination of your ears using an otoscope.

If earwax build up isn't causing any symptoms, it doesn’t need to be treated. There are people who can’t tell you about symptoms, such as people with dementia.


Ear drops

Ear drops soften wax to help it move out naturally. You can do this treatment yourself, but you shouldn’t use them if:

  • you have a hole in your ear drum (tympanic membrane perforation)
  • you've had ear surgery
  • you have an infection in your ear canal
  • you've had a middle ear infection (otitis media) in the past 6 weeks. 

You can buy ear drops from your pharmacy. They often have the ingredients acetic acid 2.5%, sodium bicarbonate 10%, carbamide peroxide, saline or mixtures such as cerumol or waxsol. Read the full instructions on the packaging.

Otherwise you can use baby oil, almond oil, or canola oil. Yes, that’s cooking oil from the supermarket. Use a dropper or teaspoon to put 2 to 3 drops in your ear twice a day for 4 or 5 days.

Make sure the drops are at room temperature or you can get dizzy. Read more about how to apply ear drops. After treatment the softened wax can take up to 2 weeks to fall out.


Procedures

If ear drops alone haven't helped the wax fall out you can have it removed. This works best if you've softened it first – your healthcare provider will advise you what to do. The procedures used to remove earwax shouldn't be painful. The safest procedure is microsuction.

Microsuction

A machine with a small sucker is used to suck the earwax out of your ear. This can be noisy.

Depending on where you live, the most cost effective way to have this done is by making an appointment with a private audiologist or some branches of Hearing New Zealand(external link).

If this isn't available to you, or if you have a community services card, you may be better to make an appointment at your medical centre. They may have a microsuction device, or they may use water or a special instrument. Children can be referred to public health ear nurses for microsuction.

The image below shows how microsuction is done with the red ball representing a plug of earwax.

Microsuction device to remove wax from ears

Image credit: Depositphotos


Syringing or ear irrigation

Warm water is squirted into your ear to weaken and loosen the wax. The wax flows out of your ear with the water. This feels strange but it shouldn't hurt

Irrigation can damage your ear including making a hole in your ear drum so it needs to be done very carefully. Your doctor or nurse can do it, or you can do it at home using a special treatment kit from your pharmacy but this is less safe. 

Irrigation isn't suitable for young children.

Manual removal

Your healthcare provider uses a thin instrument with a small loop or scoop at one end to remove the wax, while looking carefully to make sure your ear isn't damaged.

Note: Ear candles don’t work and can cause serious injury. 


Prevention

If you're an older adult, wear hearing aids, or you naturally make a lot of earwax, talk to your healthcare provider about using drops once a week for prevention.

Some people find that sugar free gum helps because the movement of muscles during chewing helps move the earwax out of the ear.

Ear drops
Tinnitus
Swimmer's ear
Ear care advice

References

  1. Removal of ear wax(external link) NZ Formulary, NZ
  2. Poulton S, Anderson D, Bennet D, et al. Earwax management(external link) Aust Fam Physician 2015;44(10):731–4
  3. Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical practice guideline (update) – earwax (cerumen impaction)(external link) Otolaryngol – Head Neck Surg. 2017;156(1S):S1–S29
  4. Aaron K, Cooper TE, Warner L, et al. Ear drops for the removal of ear wax(external link) Cochrane Database Syst Rev. 2018 Jul 25;7:CD012171

HealthPathways(external link) includes olive oil for the management of earwax, but most international sources avoid it, likely due to viscosity and occlusion of the ear canal and microsuction equipment.

Clinical guidelines

From: Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical practice guideline (update) – earwax (cerumen impaction)(external link) Otolaryngol – Head Neck Surg. 2017;156(1S):S1–S29.

The guideline includes the following recommendations.

  • Explain proper ear hygiene to prevent cerumen impaction when patients have an accumulation of cerumen.
  • Diagnose cerumen impaction when an accumulation of cerumen, as seen on otoscopy, is associated with symptoms, prevents needed assessment of the ear, or both.
  • Assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as ≥1 of the following: anticoagulant therapy, immunocompromised state, diabetes mellitus, prior radiation therapy to the head and neck, ear canal stenosis, exostoses, and nonintact tympanic membrane.
  • Don't routinely treat cerumen in patients who are asymptomatic and whose ears can be adequately examined.
  • Identify patients with obstructing cerumen in the ear canal who may not be able to express symptoms (young children and cognitively impaired children and adults), and they should promptly evaluate the need for intervention.
  • Treat, or refer to a clinician who can treat, the patient with cerumen impaction with an appropriate intervention, which may include ≥1 of the following: cerumenolytic agents, irrigation, or manual removal requiring instrumentation.
  • If symptoms persist despite resolution of impaction, the clinician should evaluate the patient for alternative diagnoses.
  • If initial management is unsuccessful, refer to clinicians who have specialised equipment and training to clean and evaluate ear canals and tympanic membranes.

Poulton S, Anderson D, Bennet D, et al. Earwax management(external link) Aust Fam Physician 2015;44(10):731–734
Michaudet C, Malaty J. Cerumen impaction – diagnosis and management(external link) Am Fam Physician 2018;98(8):525–529

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Emma Dunning, Clinical Editor and Advisor

Last reviewed:

Read more at: https://healthify.nz/health-a-z/e/earwax-build-up-and-removal/
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