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This is a PatientPlus article. PatientPlus articles are written for doctors and so the language can be technical, however some people find that they add depth to the patient information leaflets. You may find the abbreviations record helpful.

Earwax is a build up of cerumen, sebum, dead cells, sweat, hair and foreign material, e.g. dust.1 Earwax is a normal physiological substance that protects the ear canal. The quantity produced varies greatly between individuals.

Epidemiology

Impacted earwax is more common in:

  • The elderly
  • People who use hearing aids
  • Those who use ear buds
Differential Diagnosis
Management
  • Earwax needs to be removed only if it is causing symptoms or if a clearer view of the eardrum is required. The use of cotton buds to clear the ear canal should be discouraged as wax is likely to become more impacted.
  • Impacted earwax can be treated with ear drops, irrigation, microsuction or curettage. Ear drops are considered first line and often the only treatment required. Microsuction is safer than irrigation but not widely available. Complications of irrigation can be minimised by correct training and care. There is little good evidence on the relative effectiveness of the various treatment options.
  • Ear drops to soften wax:
    • Are often the appropriate first-line treatment2
    • There is little evidence on their effectiveness for the removal of symptomatic ear wax3
    • Water and sodium chloride 0.9% seem to be as effective as any proprietary agent3
    • Olive oil and almond oil are also recommended
    • Sodium bicarbonate ear drops are also effective but may cause dryness of the ear canal
    • Docusate sodium and urea hydrogen peroxide are the active ingredients in a number of preparations for softening ear wax2
  • Ear irrigation
    • Is indicated if impacted wax causes loss of hearing, discomfort or tinnitus
    • Avoid ear irrigation if there is any past or present history of perforation of the tympanic membrane, or a grommet in situ. Irrigation should only be used if absolutely necessary and with great caution in patients with previous middle ear or mastoid surgery, or recurrent otitis externa or chronic middle ear disease.
    • Drops to soften the wax should ideally have been used before irrigation is attempted
    • An electronic irrigator is safer than a syringe
    • The water should be warmed to body temperature
    • Direct the water flow backwards and along the roof of the ear canal
    • Complications of syringing occur in about 1 in 1000 ears syringed.4 These include:5
      • Bleeding (which is usually self-limited)
      • Perforation
      • Otitis externa
      • Disturbance in balance with nausea and vomiting
      • Deafness and balance difficulties (rare)
  • Several other mechanical removal techniques are available, but usually only available in secondary care:
    • Ear curettes and forceps
    • Microsuction
Complications
  • Depression and social isolation in the elderly
  • Complications of ear wax without any other ear problem are uncommon in children, but may include deafness leading to impaired speech and language development and school difficulties.


Document references
  1. Ear wax, Clinical Knowlege Summaries (2007)
  2. British National Formulary
  3. Burton MJ, Doree CJ; Ear drops for the removal of ear wax - Cochrane Review
  4. Bird S; The potential pitfalls of ear syringing. Minimising the risks. Aust Fam Physician. 2003 Mar;32(3):150-1. [abstract]
  5. Grossan M; Safe, effective techniques for cerumen removal. Geriatrics. 2000 Jan;55(1):80, 83-6. [abstract]

Internet and further reading Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2009.
Document ID: 537
Document Version: 3
Document Reference: bgp24907
Last Updated: 4 Sep 2007
Planned Review: 3 Sep 2009

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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