Bounty

Earwax

Earwax is a waxy material that is produced by sebaceous glands inside the ear. It cleans, lubricates and protects the lining of the ear by trapping dirt and repelling water.

Earwax is slightly acidic and has antibacterial properties. Without earwax, the skin inside your ear would become dry, cracked, infected or waterlogged and sore.

Earwax can be wet or dry and hard or soft. Soft earwax is more common in children and hard earwax is more likely to cause problems. Dry earwax is golden and flaky and more common in people of Asian origin.

Earwax problems

Earwax doesn't usually cause problems. However, producing too much earwax can lead to a blocked and painful ear or hearing loss.

Read more about the symptoms of earwax.

Having repeated ear infections, flaky skin near your ear, or hair in your ear canals can also put you at risk of developing problems with your earwax.

Read more about what causes earwax problems.

Every year in the UK, over two million people have problems with earwax and need it removed.

To reduce your risk of developing problems with your ears, avoid putting objects in your ears, such as cotton buds, matchsticks and hairpins.

As well as risking damage to your ear canal or eardrum, sticking things in your ears can result in earwax becoming lodged in your ear canal.

When to see your GP

Visit your GP if you are having problems with earwax. If you have a large amount of earwax, it may need to be removed.

Earwax can usually be removed using eardrops. If eardrops don't work, another treatment called ear irrigation may be recommended. It involves using a pressurised flow of water to remove the build-up of earwax. 

Do not attempt to remove earwax yourself, without first speaking to your GP.

Read more about how earwax is treated.

Symptoms

Earwax doesn't usually cause problems, but a build-up of earwax can lead to a blocked ear, pain and hearing loss.

Some people produce more earwax than others. It usually falls out of your ear gradually, in small pieces or flakes. Sometimes, earwax can build up and harden, creating a blockage called a "plug".

As well as causing discomfort, an earwax plug can also cause hearing loss because it blocks your ear canal. However, once the blockage is removed, your hearing will improve.

Read more about treating earwax.

Other symptoms

Too much earwax can also cause other symptoms such as:   

• earache
• tinnitus: the perception of noises in your ear that come from inside the body 
• itchiness

Some experts believe that earwax may also be associated with vertigo (the sensation that you are moving even when standing still). However, this link is by no means certain.

In rare cases, you may also have a cough that is caused by the stimulation of a nerve inside your ear. This occurs due to an increase in pressure created by the impacted earwax.

See your GP if you experience any of the above symptoms and are worried that your earwax may be causing problems. 

Do not attempt to remove your earwax by sticking anything in your ear, such as a cotton wool bud.

Causes

People who produce a lot of earwax are more likely to develop a blockage in their ear than those who only produce a small amount.

Who's at risk?

Your risk of developing problems due to a build-up of earwax is increased if you have:

• narrow ear canals or ear canals that aren't fully formed
• a lot of hair in your ear canals
• benign (non-cancerous) bony growths in the outer part of your ear canal (osteomata)
• a skin condition of your scalp or preauricular area (the area just in front of your earlobe)
• hard wax, because it's more likely to become impacted (firmly lodged in your ear canal)  
• a history of recurrent impacted earwax
• repeated ear infections
• learning difficulties (the reason for this is unknown) 

Elderly people are also more at risk of having earwax problems, because earwax becomes drier with age. 

Impacted earwax

If you produce a lot of earwax, further blockages may occur, even after you have had an earwax plug removed.

Further blockages are also likely to occur if you have particularly narrow ear canals that become blocked more easily.

Your chances of developing an earwax blockage are also increased if you:

• use cotton buds: they can push earwax deeper into your ear and pack it harder together, which creates an earwax plug
• wear a hearing aid or earplugs: they can stop earwax falling out of your ear naturally

Diagnosis

You don't need to have a test for your earwax to be diagnosed. If you have a history of recurrent earwax problems, you will probably know when you have another build-up of earwax.

If you have earwax-related problems, your GP or a hearing specialist will examine both ears using an instrument called an auriscope. An auriscope, also known as an otoscope, has a light at one end to allow the inside of your ear to be seen.

On examining the inside of your ear, your doctor will be able to see whether there is a build-up of earwax and whether it is impacted (firmly lodged in your ear canal). If you have hearing loss, it may be due to impacted earwax.

Treatment

In most cases, earwax falls out on its own and there is no need to remove it. However, if earwax is completely blocking your ear canal and causing hearing loss, it may need removing.

Earwax also sometimes needs to be removed to make an impression of the ear canal for a hearing aid mould, or if the earwax is causing the hearing aid to whistle.

Treatment usually starts with eardrops to soften the earwax. However, if eardrops do not work, a process called ear irrigation may be needed.

Eardrops

Your GP or a hearing specialist may prescribe eardrops to soften the earwax and make it easier to remove.

Eardrops should only be used when they are at room temperature. Pour a few drops into the affected ear and lie on your side for a few minutes with the affected ear facing upwards.

This will allow the eardrops to soak into the wax and soften it. Repeating this two or three times a day for three to five days will cause the plug to soften. It may then gradually fall out of your ear bit by bit.

Eardrops should not be used if you have a perforated eardrum.

Ear irrigation

Ear irrigation may be recommended if your earwax blockage persists, even after using eardrops. It involves using a pressurised flow of water to remove the build-up of earwax.

An electronic ear irrigator is used, rather than a metal syringe as happened in the past, to avoid damaging the ear. The irrigator has a variable pressure control so that syringing can begin at the minimum pressure.

During the procedure, a controlled flow of water will be squirted into your ear canal to clean out the earwax. The water is a similar temperature to your body.

While irrigating your ear, the healthcare professional treating you may hold your ear at different angles to ensure that the water reaches all of your ear canal.

They may also look inside your ear several times using an auriscope (an instrument designed to examine the inside of the ear) to check whether the wax is coming out.

Ear irrigation is a painless procedure, but your ear may feel strange as the water is squirted around your ear canal.

Tell the person who is treating you if you have any:

• pain
• dizziness
• vertigo: the sensation of movement when still
• hearing loss 

Symptoms such as these may be the result of an ear infection and will need further investigation.

If ear irrigation is unsuccessful at removing earwax from your ear, your GP may recommend:

• using eardrops again and returning for another irrigation
• putting water into your ear before irrigating again after 15 minutes
• that you be referred to an ear, nose and throat (ENT) specialist to remove the earwax

When ear irrigation is not recommended

Ear irrigation is not suitable for everyone. It should not be used if you have:

• previously had problems with irrigation, such as pain in your ear or severe vertigo
• a perforated eardrum, or you have had a perforated eardrum in the last 12 months
• a discharge of mucus from your ear, which may indicate an undiagnosed perforation
• had a middle ear infection (otitis media) in the past six weeks 
• a grommet (a small, hollow tube that is surgically inserted into your ear if you have a build-up of fluid that causes hearing difficulties – see below)
• had ear surgery, apart from cases of extruded grommets, within the last 18 months
• a cleft palate (whether repaired or not)
• a foreign body in your ear
• a severe external ear infection (acute otitis externa) with pain in the ear canal or pinna (the visible part of your ear)

Ear irrigation is not recommended if you have a grommet. The grommet creates a passage in your middle ear which allows water to enter during syringing.

Grommets come out naturally, and the passage created by the grommet should eventually heal. Once the passage has healed, you can have your ear irrigated.

You should not have ear irrigation if the ear to be treated is your only hearing ear. This is because there is a very small chance that it could cause permanent hearing loss.

Young children who are un-cooperative, and some people with learning difficulties, may also not be able to have ear irrigation.

Other treatments

If your earwax cannot be removed using eardrops and ear irrigation, or if you are unsuitable for these treatments, alternative options may be considered. These include:

• microsuction: a noisy and possibly uncomfortable technique that uses gentle suction under a microscope
• aural toilet: where a specialist uses an instrument called a Jobson Horne probe to manually remove the earwax

Complications

There are several complications that can occur as a result of impacted earwax or ear irrigation.

An ear infection may develop if you have untreated impacted earwax (earwax that is firmly lodged in your ear canal).

If your earwax touches your eardrum (tympanic membrane), it may cause discomfort and vertigo (the sensation that you are moving even though you are still).

The following complications have been reported from patients after their ear irrigation:

• infection of the external ear canal (otitis externa)
• middle ear infection 
• a perforated eardrum
• damage to the external auditory meatus (the tube that connects the outer ear to the middle ear)
• ear pain
• vertigo
• worsening of pre-existing tinnitus (the perception of noises in your ear that come from inside the body)

Sometimes, light bleeding can also occur which usually stops on its own. Nausea, vomiting and vertigo may occur due to variations in the temperature of the irrigating fluid.

Rarely (in about 1 in every 1,000 ears that are irrigated) serious complications can occur. These are described below.

Severe infection

In rare cases, infection may progress to the base of the skull and cause cranial paralysis, meningitis (infection of the protective membranes that surround the brain) and even death.

The elderly, people with diabetes and those with a weak immune system are most likely to be affected.

Chronic tinnitus

Long-term (chronic) tinnitus can sometimes occur following earwax removal or ear irrigation. However, this is rare.