Some people are naturally more susceptible to developing a blockage in their ear, for various reasons.

Your risk of developing problems from a build-up of earwax is increased if you have:

• narrow ear canals or ear canals that aren’t fully formed
• a lot of hair in your ear canals
• bony growths in the outer part of your ear canal – these are called osetomata
• a skin condition of your scalp or preauricular area (the area just in front of your earlobe)
• hard wax – because it’s more likely to become impacted (firmly lodged in your ear canal)  
• a history of recurrent impacted earwax
• repeated ear infections
• learning difficulties (the reason for this is unknown) 

Elderly people are more at risk of having earwax problems because earwax becomes drier with age. 

Impacted earwax

If you produce a lot of earwax, further blockages may occur, even after you’ve had an earwax plug removed.

Further blockages are also likely to occur if you have particularly narrow ear canals that become blocked more easily.

Your chances of developing an earwax blockage are also increased if you:

• use cotton buds – they can push earwax deeper into your ear and pack it together harder, creating an earwax plug
• wear a hearing aid or earplugs, which can stop earwax falling out of your ear naturally

There are several complications that can occur as a result of impacted earwax or ear irrigation.

An ear infection may develop if you have untreated impacted earwax (earwax that’s firmly lodged in your ear canal).

If your earwax touches your eardrum, it may cause discomfort and vertigo (the feeling that you’re moving even though you’re still).

The following complications have been reported from patients after having ear irrigation:

• infection of the external ear canal (otitis externa)
• middle ear infection (otitis media)
• a perforated eardrum
• damage to the external auditory meatus (the tube connecting the outer ear to the middle ear)
• ear pain
• vertigo
• worsening of pre-existing tinnitus (hearing sounds that come from inside your body rather than around you)

Light bleeding may sometimes occur, which usually stops on its own. You may also experience nausea, vomiting and vertigo because of variations in the temperature of the irrigating fluid.

Rarely (about 1 in 1,000 irrigations) serious complications can occur. These are described below.

Severe infection

In rare cases, infection may progress to the base of the skull and cause cranial paralysis, meningitis (infection of the protective membranes that surround the brain) and even death.

The elderly, people with diabetes and those with a weak immune system are most likely to be affected.

Chronic tinnitus

Long-term (chronic) tinnitus can sometimes occur following earwax removal or ear irrigation. However, this is also very rare.

Tests aren’t needed to see if you have earwax.

If you have a history of recurrent earwax problems, you’ll probably know when you have another build-up of earwax.

Ear examination

If you have earwax-related problems, your GP or a hearing specialist will examine both ears using an instrument called an auriscope. An auriscope, also known as an otoscope, has a light and a magnifier at one end so that the inside of your ear can be clearly seen.

When examining the inside of your ear, your doctor will be able to see if there’s a build-up of earwax and whether it’s impacted (firmly lodged in your ear canal). If you have hearing loss, it may be due to impacted earwax.

Earwax is a waxy material produced by sebaceous glands inside the ear. It cleans, lubricates and protects the lining of the ear by trapping dirt and repelling water.

Earwax is slightly acidic and has antibacterial properties. Without earwax, the skin inside your ear would become dry, cracked, infected or waterlogged and sore.

Earwax can be wet or dry, hard or soft. Soft earwax is more common in children and hard earwax is more likely to cause problems.

Earwax problems

Earwax doesn’t usually cause problems, but if too much earwax is produced it can lead to a blocked and painful ear or hearing loss.

Read more about the symptoms of earwax build-up.

Repeated ear infections, flaky skin near your ear, or hair in your ear canals can also increase your risk of developing earwax problems.

To reduce your risk of developing problems, avoid putting objects into your ears, such as cotton buds, matchsticks and hairpins.

As well as possibly damaging your ear canal or eardrum, sticking things in your ears can also cause earwax to become lodged in your ear canal.

Read more about what causes earwax problems.

What you can do

Eardrops, available from your pharmacy, can be used to soften and loosen the earwax, which may help it work its way out naturally. Speak to your pharmacist about which eardrops are suitable for you.

Avoid sticking cotton buds in your ears because it can push the earwax further into your ears.

When to see your GP

Ask to see the nurse at your GP surgery if you’re having problems with earwax. Don’t attempt to remove the earwax yourself without first speaking to a healthcare professional.

Your practice nurse, GP or a hearing specialist may examine the inside of your ears using an instrument called an auriscope. An auriscope, also known as an otoscope, has a light and a magnifier at one end to allow the inside of your ear to be clearly seen.

During the examination, your doctor will see if there’s a build-up of earwax and whether it’s impacted (firmly lodged in your ear canal). If you have hearing loss, it may be due to impacted earwax.

If there is a large build-up of earwax, it may need to be removed. If eardrops haven’t worked, another treatment called ear irrigation may be recommended. This involves using a pressurised flow of water to remove the earwax.

Read more about how earwax is treated.

Complications of earwax

There are several complications that can occur as a result of impacted earwax or ear irrigation.

An ear infection may develop if you have untreated impacted earwax.

If the earwax touches your eardrum, it may cause discomfort and vertigo (the sensation that you’re moving even though you’re still).

The following complications have been reported from some patients after having ear irrigation:

• infection of the external ear canal (otitis externa)
• middle ear infection (otitis media)
• a perforated eardrum
• damage to the external auditory meatus (the tube that connects the outer ear to the middle ear)
• ear pain
• vertigo
• worsening of pre-existing tinnitus (the sense that there are noises in your ear, which come from inside your body)

Read more about the complications of earwax.

Earwax doesn’t usually cause problems, but a build-up of earwax can lead to a blocked ear, pain and hearing loss.

Some people produce more earwax than others. It usually falls out of your ear gradually, in small pieces or flakes. Sometimes, earwax can build up and harden, creating a blockage called a “plug”.

As well as causing discomfort, an earwax plug can also cause temporary hearing loss because it blocks your ear canal. Once the blockage is removed, your hearing will improve.

Read more about treating earwax build-up.

Other symptoms

Too much earwax can also cause other symptoms, including:   

• earache
• tinnitus – hearing sounds that come from inside your body rather than around you
• itchiness

Some experts believe that earwax may also be associated with vertigo (the sensation that you’re moving even when standing still). However, this link is not certain.

In rare cases, you may also have a cough that’s caused by the stimulation of a nerve inside your ear. This is due to an increase in pressure created by the impacted earwax.

See your GP if you experience any of the above symptoms and are worried that your earwax may be causing problems. Don’t attempt to remove your earwax by sticking anything in your ear, such as a cotton bud.

In most cases, earwax falls out on its own, so there’s no need to remove it. However, if it’s completely blocking your ear canal and causing hearing loss, it may need to be removed.

Earwax also sometimes needs to be removed so that an impression of the ear canal can be made for a hearing aid mould. It can also be removed if the earwax is causing the hearing aid to whistle.

Eardrops

Eardrops, available from your pharmacy, can be used to soften and loosen the earwax, which may help it to work its way out naturally. Speak to your pharmacist about which eardrops are suitable for you.

Eardrops should only be used when they’re 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 eardrops to soak into the wax and soften it. Repeating this two or three times a day for between three and five days will cause the plug to soften. The wax should then gradually fall out of your ear bit by bit.

Eardrops should not be used if you have a perforated eardrum (a hole or tear in the eardrum).

Ear irrigation

Ear irrigation may be recommended if your earwax blockage persists, even after using eardrops. It involves using a pressurised flow of water to remove the build-up of earwax.

An electronic ear irrigator is used, rather than a metal syringe (which was used in the past), to avoid damaging the ear. The irrigator has a variable pressure control so that syringing can begin at the lowest pressure.

During the procedure, a controlled flow of water will be squirted into your ear canal to clean out the earwax. The water is a similar temperature to your body.

While irrigating your ear, the healthcare professional treating you may hold your ear at different angles to ensure the water reaches all of your ear canal.

They may also look inside your ear several times using an auriscope (an instrument that’s used to examine the inside of the ear) to check whether the wax is coming out.

Ear irrigation is a painless procedure, but your ear may feel strange as the water is squirted around your ear canal. Tell the person who is treating you if you experience any:

• pain
• dizziness
• vertigo – the sensation of moving when you’re still
• hearing loss 

These symptoms may be caused by an ear infection and will need further investigation.

If ear irrigation is unsuccessful at removing earwax from your ear, your GP may recommend:

• using eardrops again and returning for another irrigation
• putting water into your ear before irrigating again after 15 minutes
• that you are referred to an ear, nose and throat (ENT) specialist to remove the earwax

When ear irrigation is not recommended

Ear irrigation isn’t suitable for everyone. It shouldn’t be used if you have:

• previously had problems with irrigation, such as pain in your ear or severe vertigo
• a perforated eardrum, or if you’ve had a perforated eardrum in the last 12 months
• a discharge of mucus from your ear, which may indicate an undiagnosed perforation
• had a middle ear infection (otitis media) in the past six weeks 
• a grommet (a small, hollow tube that’s surgically inserted into your ear if you’ve had a build-up of fluid that causes hearing difficulties – see below)
• had ear surgery, apart from cases of extruded grommets, within the last 18 months
• a cleft palate (whether repaired or not)
• a foreign body in your ear
• a severe external ear infection (otitis externa) with pain in the ear canal or pinna (the visible part of your ear)

Ear irrigation isn’t recommended if you have a grommet. The grommet creates a passage in your middle ear, which allows water to enter during syringing.

Grommets come out naturally and the passage created by the grommet should eventually heal. Once the passage has healed, you can have ear irrigation.

You shouldn’t have ear irrigation if the ear to be treated is your only hearing ear. This is because there’s a small chance it could cause permanent hearing loss.

Young children who cannot tolerate it and some people with learning difficulties may also not be able to have ear irrigation.

Other treatments

If eardrops and ear irrigation prove ineffective at removing your earwax, or if you’re unsuitable for these treatments, there are some alternative options that you may want to consider. These are described below.

• Microsuction – where a special suction device is used to remove the earwax under a microscope. The procedure is quick, safe and painless, and it doesn’t involve putting liquid into your ear.
• Aural toilet – where an instrument called a Jobson Horne probe is used. A Jobson Horne probe is a thin metal instrument with a small ring at one end that the specialist can use to remove earwax from your ear canal.