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. Earwax not causing symptoms or blocking your ear canal should be left alone.
  • Usually, earwax moves slowly from the inside to the outside of your ear, where it falls out.
  • Sometimes the wax builds up and forms a plug that blocks your ear. In some cases, the wax plug falls out by itself without any treatment.
  • At other times, the build-up needs treatment or manual removal by your healthcare professional.
  • Using cotton wool buds or ear candles is not recommended.
Older woman cupping her left ear with hearing loss

Ear wax 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 the ear help the wax to move out of the ear. It is usually yellow or brown in colour. 

Close up of a boy's ear
Image credit: 123rf

Some people naturally produce a lot of wax or produce hard and dry wax that is more likely to build-up. Other factors affecting wax build-up include:

  • having hairy or narrow ear canals 
  • being an older adult, as earwax becomes drier with age
  • bony growths in the outer part of your ear canal
  • working in dusty environments
  • humid environments.

Inserting objects into your ear canal, such as cotton buds, ear plugs or hearing aids can also cause wax blockage.

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 one or both of your ears.

Prevention is best for certain groups of people, but not everyone needs it. You may need to if you are an older adult, wear hearing aids or have a history of excessive earwax. Talk to your doctor to work out whether you should have preventative treatment. There is no standard procedure for preventing earwax build-up, and for most people, nothing needs to be done unless too much wax develops. 

Many people try to clean out earwax blockage with cotton wool buds. This is not recommended as the wax is often pushed deeper inside and you risk injuring your ear canal. Also avoid ear candles as they have no proven benefit in the removal of earwax and can cause serious injury. 

Instead, use one of following treatment options:   

Ear drops

You can do this treatment yourself.

  • You can buy ear drops (eg, Waxsol) from your pharmacy to soften the wax. Read the full instructions on the packaging.
  • Alternatively you can use olive, canola or baby oil. Use 2–3 drops in your ear 3–4 times a day and do this for 3–5 days.

Read more about how to apply ear drops. 

Procedures

The procedures used to remove earwax should not cause any pain. If the procedure involves liquid, it may feel funny but should not hurt.

Syringing or ear irrigation

Warm water is squirted into your ear to weaken and dislodge the wax. The wax flows out of your ear with the water. Your doctor or nurse can do it, or you can do it at home using a special treatment kit (eg, Audiclean) from your pharmacy. 

Microsuction/manual removal

A small device is used to suck the earwax out of your ear or alternatively a thin instrument with a small hoop at one end is used to remove the wax. These procedures are generally only available from specialist audiology (ear) services, although some branches of Hearing NZ(external link) offer them.

Frequently asked questions about treatment options: ear drops, irrigation and microsuction/manual removal.

To help you choose which treatment is best for you, consider the following factors for each option.

What does it involve?

Ear drops – Putting several drops of earwax-softening products into your ears once or twice daily for 3 to 5 days.

Irrigation – Cleaning your ear canal with water to flush out the earwax.

Microsuction/manual removal – A clinician inserting a  small surgical instrument (a curette), forceps or suction tip into your ear and removing the wax.

 

Are there any age restrictions?

Ear drops – Yes, it's NOT recommended for those under 3 years and people with a hole in their eardrum (perforated eardrum).

Irrigation – No, but small children may not cooperate.

Microsuction/manual removal – No, but small children may not cooperate.

 

How long will it take?

Ear drops – Less than 5 minutes.

Irrigation  Should not take more than 30 minutes (includes preparation time).

Microsuction/manual removal  Takes a few minutes and does not need anaesthesia

 

What are the benefits?

Ear drops – It doesn't require any instrument to be used in your ear and you can do it at home without going to see a doctor.

Irrigation  Your symptoms go straight away. Your doctor or nurse can do it, or you can do it at home using special treatment kits bought from the pharmacy, such as Audiclean.

Microsuction/manual removal  Your symptoms go straight away.

 

What are the potential risks and side effects?

Ear drops – Sometimes the wax softens and completely blocks the ear canal, leading to impaired hearing. This can be treated using irrigation or microsuction.

Irrigation  Temporary dizziness, pain and/or your eardrum rupturing (bursting). 

Microsuction/manual removal  Injury to your ear canal skin, leading to bleeding or infection, discomfort and/or, rarely, tinnitus or hearing loss from the noise of the suction.

 

Are there any other factors to bear in mind?

Ear drops – See your doctor if you have a lot of pain or discomfort, or if you notice a loss of hearing.

Irrigation  This treatment is not recommended if you have pressure equalisation tubes, a hole in your eardrum (perforation) or tend to get ear infections. 

Microsuction/manual removal  Caution is advised if you are taking blood thinners and tend to bleed easily. 

Some people are naturally prone to wax building up in their ears and may need frequent treatment to remove it when it becomes a problem.

Regular use of olive oil drops (2–3 drops in each ear once a week) may reduce the build-up of wax. This can be particularly useful if you use hearing aids or ear plugs.

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

Read more about the do's and don'ts of ear care.

The following links provide further information on earwax. Be aware that websites from other countries may contain information that differs from Aotearoa New Zealand recommendations.

Earwax(external link)(external link) Ear Nurse Specialist Group, NZ
Waxy ears(external link)(external link) HealthInfo, NZ
Earwax build-up(external link)(external link) NHS, UK
Earwax(external link)(external link) Better Health, AUS

  1. Removal of ear wax(external link) NZ Formulary, NZ
  2. Earwax management(external link) Australian Family Physician, October 2015
  3. Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda BB, Hackell JM, Krouse HJ et al. Clinical practice guideline (update) – earwax (cerumen impaction)(external link) Otolaryngology – Head and Neck Surgery. 2017; 156(1S):S1–S29.
  4. Aaron K, Cooper TE, Warner L, Burton MJ. Ear drops for the removal of ear wax(external link)Cochrane Database Syst Rev. 2018 Jul 25;7:CD012171.

Clinical guidelines

From: Schwartz SR, Magit AE, Rosenfeld RM, Ballachanda  BB, Hackell JM, Krouse HJ et al. Clinical practice guideline (update) – earwax (cerumen impaction)(external link) Otolaryngology – Head and Neck Surgery. 2017; 156(1S):S1–S29.

The guideline includes the following recommendations:

  • Clinicians should explain proper ear hygiene to prevent cerumen impaction when patients have an accumulation of cerumen.
  • Clinicians should diagnose cerumen impaction when an accumulation of cerumen, as seen on otoscopy, is associated with symptoms, prevents needed assessment of the ear, or both.
  • Clinicians should 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.
  • Clinicians should not routinely treat cerumen in patients who are asymptomatic and whose ears can be adequately examined.
  • Clinicians should 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.
  • Clinicians should routinely perform otoscopy to screen for cerumen in patients with hearing aids during a healthcare encounter.
  • Clinicians should 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.
  • Clinicians should recommend against ear candling for treating or preventing cerumen impaction.
  • Clinicians should assess patients at the conclusion of in-office treatment of cerumen impaction and document the resolution of impaction. If the impaction is not resolved, the clinician should use additional treatment. If full or partial symptoms persist despite resolution of impaction, the clinician should evaluate the patient for alternative diagnoses.
  • Finally, if initial management is unsuccessful, clinicians should refer patients with persistent cerumen impaction to clinicians who have specialised equipment and training to clean and evaluate ear canals and tympanic membranes.

Ear wax management(external link) Australian Family Physician, 2015
Diagnosis and management of cerumen impaction(external link) AAFP, 2009

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

Reviewed by: Dr Mathew Van Rij, GP, Lower Hutt

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