Earwax and Blocked Ears: When Is Earwax Removal Necessary?
Do your ears feel blocked, or have you noticed a gradual reduction in hearing? One possible explanation is a build-up of earwax. However, earwax is a natural and important part of ear health, and it does not always need to be removed.
Many people regularly clean their ears with cotton buds, believing that earwax is something harmful or unhygienic. In reality, unnecessary cleaning can sometimes cause more problems than it solves.
So when is earwax removal actually necessary, and which methods are considered safe?
What is earwax, and why do we need it?
Earwax, medically known as cerumen, is a natural substance produced by glands in the skin of the external ear canal.
It serves several important functions:
Protection: It helps trap dust, dirt and small particles before they reach the eardrum.
Lubrication: It prevents the delicate skin of the ear canal from becoming excessively dry.
Natural defence: It contributes to the ear canal's protective environment and helps inhibit the growth of some bacteria and fungi.
The ear also has a remarkable self-cleaning mechanism.
As the skin of the ear canal gradually moves outwards, it carries earwax towards the entrance of the ear, where it usually dries and falls away naturally.
For most people, the ears clean themselves without any intervention.
When does earwax become a problem?
Sometimes earwax accumulates faster than it can be naturally removed, forming a plug that partially or completely obstructs the ear canal.
This is known as earwax impaction (cerumen impaction).
Possible symptoms include:
A blocked or full sensation in the ear.
Reduced or muffled hearing.
Tinnitus (ringing or buzzing in the ear).
Itching or discomfort in the ear canal.
Occasionally, earache.
Symptoms may develop gradually or become particularly noticeable after swimming or showering.
However, not every blocked ear is caused by earwax. Similar symptoms can occur with middle-ear problems, Eustachian tube dysfunction, ear infections or other conditions.
Therefore, examination of the ear is important before assuming that earwax is responsible.
Who is more likely to develop an earwax blockage?
Certain factors may increase the likelihood of earwax accumulation:
Narrow or unusually shaped ear canals: These can interfere with the normal outward movement of earwax.
Hearing aids and earplugs: Devices worn inside the ear canal may obstruct the natural clearance of wax.
Frequent use of cotton buds: These can push earwax deeper into the canal.
Older age: Earwax may become drier and harder, making natural removal less effective.
A previous history of recurrent earwax blockage: Some people naturally produce or retain more wax than others.
Even in these situations, routine ear cleaning is not necessarily required.
When is earwax removal necessary?
Earwax generally needs to be removed when it causes symptoms or prevents proper examination of the ear.
Removal may be recommended if:
Earwax is causing hearing loss or a persistent blocked sensation.
The accumulation is associated with troublesome symptoms.
The eardrum cannot be adequately examined.
Earwax is interfering with a hearing test or the fitting of a hearing aid.
By contrast, a small amount of earwax in an otherwise healthy, symptom-free ear is usually best left alone.
The objective is not to make the ear canal completely free of wax, but to maintain normal ear function and allow appropriate examination when needed.
How can earwax be safely removed?
Several methods are available, depending on the consistency of the wax, the anatomy of the ear canal and the patient's medical history.
1. Earwax-softening drops
Specially formulated ear drops or suitable oil-based preparations may help soften hardened earwax and sometimes allow it to clear naturally.
However, ear drops should not be used without professional advice if you have a known or suspected perforated eardrum, grommets, previous ear surgery or ear discharge.
2. Microsuction
Microsuction is a technique in which earwax is removed using a small suction instrument under direct visual control, usually with a microscope or endoscope.
It allows the clinician to remove wax precisely without flushing water into the ear canal.
The procedure is generally well tolerated, although the suction can sound loud and may occasionally cause temporary discomfort or dizziness.
3. Manual removal
Under appropriate magnification, an ENT specialist may remove wax using fine instruments, such as a hook or curette.
The choice of instrument depends on the location and consistency of the wax.
4. Ear irrigation
In suitable patients, earwax can also be removed using controlled irrigation with water.
However, irrigation is not appropriate for everyone. It should generally be avoided in patients with a perforated eardrum, grommets, certain previous ear operations or an active ear canal infection.
The most appropriate method should always be selected following an assessment of the ear.
What should you avoid when cleaning your ears?
One of the most common mistakes is inserting cotton buds into the ear canal.
Although this may remove a small amount of visible wax, it often pushes the remaining wax deeper towards the eardrum.
It can also injure the delicate skin of the ear canal or even damage the eardrum.
Avoid:
Inserting cotton buds, hairpins or other objects into the ear canal.
Attempting to scrape out hardened wax yourself.
Using ear candles, which are ineffective and can cause injury.
Repeatedly irrigating your ears at home without knowing whether your eardrum is intact.
For everyday hygiene, it is usually sufficient to clean the outer ear gently with a soft cloth.
There is no need to clean deep inside the ear canal.
When should you consult an ENT specialist?
An ENT examination is advisable if you experience:
Persistent or recurrent blocked ears.
Gradually worsening hearing.
Ear discomfort or tinnitus.
Recurrent earwax accumulation.
Symptoms that do not improve after appropriate earwax removal.
Sudden hearing loss should never automatically be attributed to earwax. It requires prompt medical assessment, as some causes need urgent treatment.
Severe ear pain, ear discharge, bleeding or significant dizziness also warrant medical evaluation.
If hearing remains reduced after the earwax has been removed, further assessment, including a hearing test, may be necessary.
The important message: earwax is not the enemy
Earwax is a normal and beneficial part of the ear's protective system.
Healthy ears do not require routine deep cleaning. Treatment is appropriate when wax causes symptoms, obstructs examination or interferes with hearing assessment.
When removal is needed, a professional examination helps determine the safest and most suitable technique.
At PARK-ENT, we assess the ear canal and eardrum and, when indicated, can perform earwax removal under direct visual control.
References
Schwartz SR et al. Clinical Practice Guideline (Update): Earwax (Cerumen Impaction). Otolaryngology–Head and Neck Surgery. 2017. DOI: 10.1177/0194599816671491
National Institute for Health and Care Excellence (NICE). Hearing Loss in Adults: Assessment and Management. Guideline NG98, Section 1.2: Removing Earwax. NICE Guidance
