Ear Wax and Hearing: Safe Care

What ear wax is and why it builds up

The outer part of the ear canal produces wax and oil. The skin of the canal grows slowly outwards, carrying wax and dead skin cells to the opening, where it dries and falls away. Chewing and jaw movement help. Problems arise when:

• The canal is narrow, twisted or hairy, so wax cannot escape.
• Wax is dry and hard, which is common with age, as the glands produce drier wax.
• Hearing aids, earphones or earplugs block the exit and push wax back in, and can stimulate more production.
• Cotton buds and fingers push wax inwards and pack it.
• Skin conditions or excess skin flakes in the canal.
• Bony growths in the canal.
• Dementia or limited ability to self-care, with unnoticed build-up.

Wax is not dirt and does not need regular removal. Only wax that causes symptoms, or that hides the eardrum from a clinician, needs to be dealt with.

Signs of a wax blockage

• Reduced or muffled hearing, often gradual, sometimes suddenly after a shower or swimming, when wax swells with water.
• A feeling of fullness or blockage in the ear.
• Itching, discomfort or mild pain.
• Ringing or buzzing (tinnitus); see ringing in the ears (tinnitus) at home.
• Hearing aid whistling (feedback) or a weak sound from the aid, even with fresh batteries; see hearing aid care, batteries and troubleshooting.
• Dizziness or a cough triggered by the ear canal.
• Changes in behaviour: a person with dementia may become more agitated, pull at an ear or withdraw if the ear is blocked.

Wax can contribute to hearing loss, but it is also easy to blame wax for hearing loss that has another cause, such as nerve-related loss. See signs of hearing loss in parents and how to raise it gently. A doctor should look in the ear to see what is happening.

What not to do

• Do not use cotton buds, hairpins, matchsticks, keys, toothpicks or any object inside the ear canal. They push wax deeper, can scratch the canal and can perforate the eardrum.
• Do not use ear candles. Ear candling has no proven benefit and has caused burns, wax deposits and eardrum injury. It is also a fire hazard, particularly dangerous around an older person or near oxygen.
• Do not let street ear-cleaners or untrained persons clean the ears with metal instruments, tools or by suction. These can cause infection and injury.
• Do not squirt water with a syringe or a pressure device at home. High pressure can damage the eardrum, and water left behind can cause infection.
• Do not use oil, hydrogen peroxide, vinegar, alcohol or commercial drops without asking, especially if there has been ear pain, discharge, a perforated eardrum, ear surgery, a grommet or ear tube, or if the person has diabetes or a weak immune system.
• Do not put anything in an ear that is painful, discharging or bleeding.
• Do not remove wax if the person cannot cooperate or may jerk the head, such as in dementia, without professional help.
• Do not try to clean the ears too often. Over-cleaning removes the protective wax and may cause irritation and more wax.

What may be safe, with a doctor's agreement

For a simple wax blockage in an adult with an intact eardrum and no ear symptoms, doctors often suggest softening the wax with drops for several days, which may allow it to come out on its own. Typical options include olive oil, almond oil or sodium bicarbonate-based ear drops. This is the approach described in clinical guidance such as the NICE clinical knowledge summary on ear wax. Ask your doctor, nurse or pharmacist first, because it is not suitable for everyone. General points when advised:

• Warm the bottle slightly in the hand (not hot).
• Lie with the affected ear up, put in the drops as instructed, and stay for a few minutes, with a cotton ball at the opening if advised.
• Use for the number of days stated, typically a few, then reassess.
• Wipe the outside of the ear only, gently.
• Stop and see a doctor if there is pain, discharge or worsening hearing.
• Do not use a device inside the canal.

If the wax does not clear, a clinician can remove it. Hearing aid users who produce wax repeatedly may be advised on a regular schedule of drops and professional checks, and an audiologist can show how to protect the aids with wax guards.

Professional removal

Depending on the situation, the doctor, nurse, audiologist or ENT specialist may use:

• Irrigation (ear syringing): water, at body temperature, gently flushed into the canal to wash out wax. It is not suitable if there is a perforated eardrum, previous ear surgery, an ear infection, a grommet, a narrow canal or other problems, and carries a small risk of damage and dizziness.
• Microsuction: the clinician looks in with a microscope or a headlight and magnification, and gently suctions wax. It avoids water and is often preferred, particularly for people with a risk of infection, diabetes, a perforated eardrum or a history of ear problems.
• Manual removal with small instruments, such as curettes or small hooks, by a trained clinician with a clear view.

Complications are uncommon but can include temporary dizziness, ringing, ear pain, infection or damage to the skin or eardrum. Tell the clinician about previous ear surgery, perforation, infection, grommets, diabetes, blood thinners or a weak immune system. Ask where such services are offered locally, since availability varies. Cost varies by clinic.

Hearing aid users: special advice

• Check and clean the aids daily, replace wax guards, and keep the canal tips clean.
• Have the ears checked at least yearly, or when the aid weakens or whistles.
• Do not wear aids with a painful, discharging or infected ear; see the doctor.
• Ask the audiologist how often wax should be checked and who can remove it.
• Make sure earmoulds fit, since a poor fit may trap wax.
• See hearing aids: types, costs and how to choose and the first weeks with a hearing aid: what to expect.

It might not be wax

A blocked or muffled ear is not always wax. Other causes include:

• Fluid behind the eardrum, often after a cold.
• An infection of the canal (otitis externa), with pain, itching and discharge.
• A middle ear infection.
• A perforated eardrum.
• Age-related or noise-related hearing loss.
• Eustachian tube problems, after flying or a cold.
• Foreign bodies, such as cotton, insects or pieces of earbuds.
• Growths or other conditions found by the ENT doctor.
• Medicines affecting hearing.

If hearing is still reduced after wax is removed, a hearing test is needed; see a hearing test: what to expect.

Warning signs: seek medical care promptly

• Sudden hearing loss in one or both ears: an emergency, needing assessment within a day or so; see signs of hearing loss in parents and how to raise it gently.
• Ear pain, discharge, bleeding or a foul smell.
• Swelling, redness or tenderness of the ear or behind it.
• Fever with ear pain.
• Dizziness, vertigo, vomiting or facial weakness; call 112 if with weakness, speech difficulty or confusion. See vertigo, BPPV and balance problems.
• An object stuck in the ear, an insect or a battery from a hearing aid or toy. Do not poke; go to a doctor. A button battery in the ear is an emergency.
• Hearing that does not recover after wax removal.

Looking after ears day to day

• Wipe the outer ear with a damp cloth when washing; do not go into the canal.
• Dry the outer ear gently after a bath. Avoid getting soapy water in the ear.
• Keep hair oil and cosmetics out of the ears.
• Protect the ears from loud noise and from water if there is a perforation or tubes.
• Treat colds and allergies that affect the ears.
• Tell the doctor about itching, flaking skin or eczema in the ear.
• Encourage regular ear checks as part of routine care, especially with hearing aids; see a hearing and vision check-up schedule after 60.
• For a parent with dementia, a carer may need to arrange periodic checks, as the person may not report symptoms; see caring for a parent with dementia at home.

When to ask a professional

See a doctor, nurse, audiologist or ENT specialist for a blocked ear, hearing aid problems, itching or any ear symptoms. Ask about safe softening drops and how to apply them. Ask for removal by a trained clinician with the right method for your parent's ears. Seek urgent help for sudden hearing loss, ear pain, discharge, bleeding, dizziness or fever. Call 112 for sudden hearing loss with weakness, facial droop, severe dizziness or confusion.