Ear Wax Buildup: Causes, Symptoms and When to See an ENT

Ear wax, known medically as cerumen, is one of the body's natural protective substances. It traps dust, debris, and bacteria before they can reach the eardrum and deeper ear. However, when wax accumulates or becomes impacted, it can lead to discomfort, muffled hearing, or a feeling of fullness in the ear. This article explains why buildup happens, how to tell when wax is the problem, and when it is time to have it removed by an ENT.

Why Ear Wax Builds Up

The ear canal is self-cleaning. In most cases, old ear wax naturally migrates outward as new wax is produced, eventually flaking away or washing out during bathing. However, certain factors can disrupt this process and lead to buildup.

Frequent use of earbuds, hearing aids, or earplugs can push wax deeper into the canal. Some individuals naturally produce more wax than others, or produce a drier type that does not migrate as easily. Narrow or unusually shaped ear canals may also contribute to accumulation. Age can play a role as well, since ear wax tends to become drier and harder as we get older. Cotton swabs are a common cause too: they push wax back toward the eardrum, where it packs down and cannot work its way out.

Signs of Ear Wax Buildup

Wax that is not causing symptoms does not need to come out. The AAO-HNS guideline (Schwartz et al., 2017) defines a problem, called cerumen impaction, as wax that causes symptoms or keeps a doctor from seeing the eardrum. Signs that wax may be blocking your ear include:

• Muffled hearing in one or both ears
• A full, plugged or blocked feeling
• Itching in the ear canal
• Ringing in the ear (tinnitus)
• A hearing aid that whistles, sounds weak or keeps clogging

Wax usually causes fullness rather than pain. Ear pain, drainage, bleeding or dizziness point to other problems, such as an infection, and should be checked rather than treated as wax.

What You Can Do at Home

For mild buildup, softening drops are a reasonable first step. Over-the-counter options typically contain saline, mineral oil, baby oil, glycerin, or a hydrogen peroxide-based solution, and no type has been shown to work better than another. Used for a few days, they soften the wax so it can work its way out on its own. Our step-by-step guide to managing earwax at home shows how to put the drops in and what to expect.

Do not try to flush the wax out yourself with a syringe or water. If your ear still feels blocked after 4 or 5 days of drops, call us. If you have ear tubes, use only ear drops we prescribed; if you have a perforated eardrum or have had ear surgery, check with us before using any drops.

What to Avoid

Cotton swabs are one of the most common causes of impacted ear wax and ear canal injuries that our specialists see. Inserting anything into the ear canal, including swabs, bobby pins, keys, or other objects, can push wax deeper and potentially damage the ear drum or canal lining. Flushing the ear with a syringe, water flosser or other water device can injure the ear as well.

Ear candling, a practice that involves placing a hollow cone-shaped candle in the ear and lighting it, has not been shown to effectively remove wax. It can also cause burns, ear canal obstruction from candle wax, and even perforation of the ear drum. The AAO-HNS guidelines specifically recommend against ear candling.

Over-cleaning can also be problematic. Removing all ear wax leaves the ear canal without its natural protection, which may increase the risk of irritation or infection.

When Should You See an ENT?

While mild ear wax buildup can often be managed at home, certain situations call for evaluation by a board-certified ENT. You should consider scheduling an appointment if you experience:

• An ear that is still blocked after 4 or 5 days of softening drops
• Significant hearing loss or persistent muffled hearing
• Ear pain, drainage, or bleeding
• Ringing in the ear (tinnitus) that does not resolve
• Dizziness or balance problems
• A history of ear surgery, ear tubes, or a perforated ear drum

Hearing that drops suddenly in one ear is not a wax problem until proven otherwise: it needs to be seen as soon as possible, and definitely within two weeks. Read more about sudden hearing loss in one ear.

How We Remove Ear Wax in the Office

Professional ear wax removal is a quick, safe procedure. Our physicians and physician assistants look directly into the ear and remove the wax with gentle suction or small instruments such as forceps and tiny loops. Because they can see the wax and the eardrum the whole time, they can clear stubborn or impacted wax without pushing it deeper or injuring the ear canal, and most patients notice their hearing come back right away. Tell us if you take a blood thinner.

Once the ear is clear, we can look for anything else that might explain your symptoms. If muffled hearing or ringing continues, our audiologists can test your hearing. For patients who use hearing aids, or whose wax builds up again and again, regular cleanings in the office can help, and we can talk through prevention, such as using softening drops from time to time.

A Note on Children and Ear Wax

Children can experience ear wax buildup just like adults. However, their ear canals are smaller and more sensitive. Parents should avoid inserting anything into a child's ear canal. If a child complains of ear discomfort, muffled hearing, or if wax is visible at the ear opening, an evaluation can help determine whether removal is needed. For children with ear tubes, professional removal is especially important to avoid complications.

The Bottom Line

Ear wax is a normal, protective substance, and most people do not need to do anything to remove it. When buildup does cause symptoms, softening drops and patience are often enough. Avoid cotton swabs, ear candles and flushing the ear yourself, and see an ENT if your ear is still blocked after a few days of drops or if you have risk factors that make home care unsafe. At Capital ENT, our board-certified ENT specialists and physician assistants provide safe, quick ear wax removal and complete ear care for patients of all ages.

Sources

• Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical Practice Guideline (Update): Earwax (Cerumen Impaction). Otolaryngology–Head and Neck Surgery. 2017;156(1_suppl):S1-S29.
• American Academy of Otolaryngology–Head and Neck Surgery. Earwax (Cerumen Impaction). ENThealth.org.