Impacted Earwax

What is impacted earwax?

Earwax is a waxy, yellowish substance that lines the inside of your ear canal. The ear canal is the tube that runs from your outer ear to your eardrum. The wax helps protect your canal from water, infection, injury, and foreign objects. But too much wax buildup can cause problems. This buildup is called impacted earwax.

Special glands in your ear make secretions that combine with dead skin cells to form earwax. The earwax travels with slowly growing cells of your skin. Over time, the earwax moves from the inner part of your ear canal to the entrance of the canal. Jaw movement also helps the earwax move through the canal.

Some things can cause problems with this normal process. Any type of blockage in the canal can cause a problem. Some people also may make too much earwax. This causes it to build up in the ear canal. The earwax may not totally block your ear canal. Most people have just a little buildup of earwax, which doesn’t cause any symptoms at all.

Impacted earwax is very common. As you get older, earwax tends to become harder and less mobile. Older adults are more likely to have problems with too much earwax. It can cause symptoms, such as hearing loss. It can also prevent a full exam of the ear.

What causes impacted earwax?

Earwax buildup happens when your ear makes earwax faster than your body can remove it. This can happen with many health conditions, such as:

• Bony blockage (osteoma or exostoses)

• Infectious disease, such as swimmer’s ear (external otitis)

• Skin disease (such as eczema)

• Autoimmune disease (such as lupus)

• Narrowed ear canal (from birth, chronic inflammation, or injury)

• Making too much earwax due to injury

Some of these conditions cause a physical blockage. Others cause more earwax to be made. In some cases, the cause of impacted earwax isn't known.

Objects placed in your ear can also lead to impacted earwax, especially if done repeatedly. This is more likely in children and young people who have no other problems with their ear canals. For example, if you use cotton swabs to remove earwax, you may push the wax deeper into your canal. Over time, this may cause complete blockage. Hearing aids, swimming plugs, and swim molds can have a similar effect with repeated use.

Who is at risk for impacted earwax?

You may be at increased risk if you have a health condition that can cause increased earwax buildup, such as eczema. You may also increase your risk if you keep putting objects in your ear, such as a hearing aid. Older adults and people with thinking (cognitive) problems also have an increased risk.

What are the symptoms of impacted earwax?

Earwax often doesn't cause any symptoms, unless it builds up a lot. These are the most common symptoms of impacted earwax:

• Hearing loss

• Earache

• Sense of ear fullness

• Itching in the ear

• Dizziness

• Ringing in the ears

• Cough

You might have only 1 or 2 of these symptoms. They often happen slowly.

The symptoms of impacted earwax may seem like other health conditions or problems. Always see your healthcare provider for more information.

How is impacted earwax diagnosed?

Your healthcare provider can diagnose impacted earwax by taking your health history and giving you a physical exam. This might include some simple hearing tests. Your provider should easily see the wax when looking at your ear through a device called an otoscope.

Your provider might diagnose you with impacted earwax even if you don’t have any symptoms. For example, you might need an ear exam for another reason. If you have so much earwax that your provider can’t see into your ear canal, they might diagnose you with impacted earwax.

How is impacted earwax treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

If you have symptoms of impacted earwax, your healthcare provider will likely advise some kind of treatment. If you don’t have any symptoms, your provider likely won't advise treatment, unless you need an ear exam for other reasons. Often the earwax goes away on its own with time. In rare cases, removing earwax can cause problems. Providers may advise removal for people who can’t talk about their symptoms, such as young children.

Treatment choices include:

• Medicines dropped into the ear canal, to soften the earwax and slowly break it down

• Irrigation of the ear canal with water in your provider’s office

• Manual removal, using special tools in your provider’s office

Your healthcare provider might advise one of these choices, partly based on your other health conditions. You might need a combination of these methods for the best removal.

Providers don't advise using other home methods of earwax removal (such as ear candling and ear vacuum kits). Studies have shown these methods don’t work well.

What are possible complications of impacted earwax?

Impacted earwax itself doesn't often cause problems. But in rare cases, some treatments for earwax removal cause the following complications:

• Swimmer’s ear (otitis external)

• Earache

• Short-term (temporary) hearing loss

• Dizziness

• Retention of water in the canal

• Eardrum hole (perforation)

• Ringing in the ears

• Bleeding from the ear

Different removal methods have different risks for these complications. Your own risk depends on your other health conditions. For instance, people with diabetes may have a greater risk for swimmer’s ear. Talk with your healthcare provider about the risks that most apply to you.

Can impacted earwax be prevented?

You may not be able to prevent impacted earwax if you have certain health conditions that make it more likely to have earwax buildup, such as eczema. But if you don’t have these types of health conditions, you might be able to prevent repeated episodes. Using a topical agent once a week may help. You may also need to plan for a regular ear cleaning every 6 months or so. Healthcare providers advise not using cotton swabs. They often push the earwax farther back down your ear canal.

When should I call my healthcare provider?

Call your healthcare provider if you have severe symptoms after your earwax removal, such as bleeding from your ears or major ear pain.

Key points about impacted earwax

• Earwax is a normal substance that helps protect the inside of your ear canal.

• When too much earwax builds up (gets impacted), it can cause symptoms, such as temporary hearing loss.

• It is more common in older adults.

• Certain health conditions make it more likely to have impacted earwax.

• You might need special drops to help remove your earwax. Or you might need an office procedure to remove it. Never try to remove your own earwax manually.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends..