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Doctor, my ears are full of wax! Please help!

Hello and TGIF! Welcome to another Dr Euan's ENT Blogpost!

For today's topic, we're going to be talking about ear wax.

Many people can feel like their ears are full of wax and gunk, or that they are itchy and you can't reach inside, but how should you go about cleaning out wax?

Well let's have a look together, shall we?

Q: What is ear wax buildup?

Ear wax, also known as cerumen, is produced by ceruminous glands in the ear canal.

Ear wax seems to trap bacteria and other particles in the ear canal and drain out to prevent infections

Although we are still not completely sure why we have ear wax, it does trap dust and other small particles and prevent them from reaching and possibly damaging or infecting the eardrum. Normally, the ear wax dries up and falls out of the ear, along with any trapped dust or debris. Everyone makes ear wax, but the amount and type are genetically determined just like hair colour or height. Smaller or oddly shaped ear canals may make it difficult for the wax our ears produce naturally to make it out of the canal. This can lead to ear wax impaction or earwax buildup.

Q: What can cause ear wax buildup?

Blockage, or impaction, often occurs when the ear wax gets pushed deep within the ear canal. Earwax blockage is one of the most common ear problems doctors see.

  • The most common cause of impactions is the use of cotton buds or Q tips (and other objects such as bobby pins and rolled napkin corners), which can remove superficial wax but they also push the rest of the wax deeper into the ear canal, causing impaction.

  • Hearing aid and earplug users are also more prone to earwax blockage, as their ear molds / ear piece may push the wax inwards when the patient is fitting the aid on.

Q: What are the symptoms of ear wax build up?

Symptoms of an earwax impaction can include:

More serious symptoms could mean you’ve developed an infection. Watch out for:

  • Serious ear pain (Otalgia)

  • Drainage, discharge, or pus from the ear canal (Otorrhea)

  • Ear Itching

  • Odour coming from the ear

  • Fever and Headache from severe Otitis Externa

Q: What are some simple ear wax treatments to clean my ears and self-care at home?

If you do not have a perforation (hole) or a ventilation tube (grommets) in your eardrum, your doctor may recommend that you try an earwax removal method at home.

  • You can soften earwax by putting a few drops of baby oil, mineral oil, olive oil, glycerin, hydrogen peroxide, or over-the-counter wax softening drops such as Waxsol into the affected ear canal. That may be enough to get the wax to come out on its own.

  • After you have tried a wax softener for a few days, use a bulb-type syringe to gently flush the ear with warm water. The water should be at body temperature to help prevent dizziness.

  • You can buy over-the-counter kits that combine softening drops with an irrigation system. Your doctor can explain which one might work for you and how to use it.

Ear candling is not recommended.

Ear candling is sometimes offered as part of spa treatments but does not help remove wax

The procedure uses a hollow cone made of paraffin and beeswax with cloth on the tapered end. The tapered end is placed inside the ear, and an assistant lights the other end, whilst making sure your hair does not catch on fire. In theory, as the flame burns, a vacuum is created, which draws the wax out of the ear. However, limited clinical trials, however, showed that in fact no vacuum was created, and no wax was removed. Furthermore, this practice may result in serious injury for example, if the candle wax accidentally flows into the ear canal and solidifies inside the ear.

You can read about my time with a patient who had an unpleasant experience with wax in my previous blogpost on ear candling.

Q: What can I expect when I see the ENT Doctor for ear cleaning?

Usually, the ENT Doctor will inspect your ears for any wax buildup or discharge.

In our clinic, we provide OTOSCOPIC imaging to take photos that are documented for you or your GP to refer to. It is true that a PICTURE is worth a 1000 words.

Otoscopic image of the ear canal and eardrum (tympanic membrane)

Once you can see the inside of your ear, you will better understand what is wrong and what needs to be done.

For Ear Wax impaction, the ENT doctor will assess how impacted the wax is, and if it needs to be softened prior to clearing the wax. This is to ensure your comfort and to make the procedure as painless as possible.

If so needed, the ENT doctor may prescribe you some Olive oil or Waxsol ear drops to apply daily for 1 week, and arrange for you to come back to remove the softened wax. In the clinic, we can remove earwax during an aural toilet, or an aural micro-suction.

Built-up earwax can be removed during an ear cleaning (aural toilet)

This is especially important for young children and people who have a fear of ear cleaning. It is important to make the procedure as comfortable and painless as possible.

For Adults, sometimes the ear wax can be dry and hard and enmeshed with the hairs in the ear canal, making it more difficult / painful to remove. So sometimes the ear clearance is staged between 2 visits, if the patient feels too afraid.

In very unusual cases, e.g. KERATOSIS OBTURANS, there is an abnormal build-up of ear wax and keratin in the ear canal, so much so that the ENTIRE ear canal is occluded and even expanded by the sheer accumulation of the wax and keratin.

Otoscopic image of eardrum obscured by buildup of Keratosis Obturans

In such cases, we may have to do the Ear Clearance under General Anaesthesia (GA) in the operating room as it is impossible to soften the buildup / remove the keratosis. Fortunately, such cases are rare and we see them about once a year.

Q: What can go wrong if I mismanage my ear wax buildup?

Problems can occur if earwax is not removed carefully and correctly. Some complications include:

You can read my advice on these topics by clicking on the blogpost links above.

Q: How can I prevent ear wax build up?

You should use cotton buds for removing excess water from the ear canal, for example after showering. However, make sure not to dig too deep as you could push the wax all the way in, up to the eardrum. Therefore you can help to prevent ear wax blockage by avoiding the use of cotton-tipped swabs (like Q-tips) and other objects that push the wax deeper into the ear canal. If you need an ear cleaning, you can check with your local GP to have a look, or you can visit our clinic.

We often advise our patients "NOT to put anything smaller than your elbow into your ear."

If you are interested to delve deeper into all things WAXY, here are some useful references you can look up.

Till next time, Have a restful and relaxing weekend :-)

Dr Euan

If you would like to seek consultation or treatment for ear wax buildup or ear cleaning, please feel free to Contact Us at Euan's ENT Surgery & Clinic to make an appointment.


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