In the majority of cases, earwax falls out on its own without the need to remove it. However, if earwax is totally blocking your ear, or if any of the following symptoms are present, it may need to be removed:
- hearing loss,
- earache,
- tinnitus (noises in your ear),
- vertigo (the sensation of movement while still), or
- a cough.
If you have a build up of earwax that becomes impacted and forms a plug, treatment to remove it may be recommended. Initially, ear drops to soften the plug may be used. If ear drops do not work, a process known as irrigation may be required.
Sometimes, earwax may also need to be removed in order to make an impression of the ear canal for a hearing aid mould, or if the earwax is causing the hearing aid to whistle.
Ear drops
Your GP or a specialist may prescribe ear drops to soften your earwax, making it easier to remove. Ear drops containing sodium bicarbonate (5%), sodium chloride (0.9%), and olive oil or almond oil may be prescribed for 3-5 days to soften the wax. If you have a perforated ear drum, eardrops will not be prescribed.
Ear drops should always 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 ear drops to soak into the wax and soften it. If you repeat this 2-3 times a day for between 3-5 days, the plug should soften and may gradually fall out of your ear bit by bit.
Ear irrigation
If after using ear drops the earwax blockage persists, irrigation may be recommended.
Irrigation involves using a pressurised flow of water to remove the build-up of ear wax. Nowadays, an electronic ear irrigator should always be used, rather than a metal syringe to avoid causing damage to the ear. The irrigator has a variable pressure control so that syringing can be started at the minimum pressure.
You will usually be sitting down during the procedure while a health professional squirts a controlled flow of water (which is around body temperature) into your ear canal in order to 'clean' out the ear wax. The person may hold your ear at different angles in order to straighten your ear canal to ensure that the water jet reaches all areas. During the procedure, the health professional will look inside your ear a number of times using an auriscope (instrument for examining the ear) to check whether the wax is coming out.
The irrigation procedure is painless, but you will usually experience a strange sensation in your ear as the water jet is squirted around your ear canal. Tell the person who is irrigating your ear, if you experience pain, dizziness, vertigo, or hearing loss during the irrigation procedure.
If irrigation proves unsuccessful at removing your earwax, your GP may recommend one of the following:
- using ear drops for a further 3-5 days and then returning for another irrigation,
- placing water into the ear before irrigating again after 15 minutes, or you may be referred to an ear, nose and throat specialist (ENT) for removal of the wax.
Ear irrigation is not suitable for everyone
Ear irrigation is not suitable for everyone and should not be used if you have:
- had previous problems with irrigation, such as pain or perforation,
- perforation of the tympanic membrane (eardrum),
- a history of perforation of the tympanic membrane in the last 12 months,
- a mucus discharge from your ear (which may indicate an undiagnosed perforation within the last 12 months),
- had a middle ear infection in the previous six weeks,
- a grommet. A grommet is a small, hollow tube that is sometimes surgically inserted into your ear if you have a build up of fluid that causes hearing difficulties. Ear irrigation is not recommended if you have a grommet because the grommet creates a passage in your middle ear, allowing water to enter during syringing,
- had any ear surgery within the last 18 months, apart from cases of extruded grommets. Grommets extrude (come out naturally) and the passage that was created by the grommet eventually heals. If you have had a grommet that has come out naturally and you have been discharged by the ENT department (ear, nose and throat) the passage will have healed. Therefore, you will be able to have your ear syringed if required. However, in practice, grommet surgery is most commonly carried out in children who do not have impacted earwax, and this situation is therefore rare,
- a cleft palate (whether repaired or not), or
- acute otitis externa (external ear infection) with a painful ear canal, or pinna (the visible part of your ear).
You should also not have irrigation if the ear to be treated is your only hearing ear, as there is a small chance that irrigation could cause permanent deafness. Young children who are uncooperative should also not have irrigation.
Other treatments for removing earwax
If your earwax cannot be removed using ear drops or irrigation, or if you are unsuitable for these treatments, a number of other treatment options may be considered including:
- microsuction - a technique that uses a gentle level of suction under a microscope. The procedure is noisy and may be uncomfortable, or
- aural toilet - under direct vision, the specialist will use an instrument known as a Jobson Horne probe to remove the wax.
Although there is no clinical evidence to show the effectiveness of mechanical methods of removing earwax (apart from irrigation), many ear, nose and throat specialists (ENT) regard microsuction as a routine treatment method.
If, after your earwax has been removed, you still have a hearing difficulty, your hearing will be retested. In some cases, it is possible for people who have a build up of earwax to have a hearing impairment that is not caused by the earwax itself. Therefore, removing the earwax will not relieve the symptoms of hearing loss, and the cause will need to be investigated further.
Ear candling
Ear candling should not be used as a method of removing earwax. It involves burning a hollow candle with one end in the ear canal to create a negative pressure to draw the earwax out of the ear canal. Clinical studies have shown that ear candling is not an effective method of removing earwax. You should never attempt to remove earwax yourself.
