Managing Ear Wax in Adults

Patient Information

District Nursing and Ear Care Services

• Author ID:            NM
• Leaflet Ref:          CM 110
• Version:               3
• Leaflet title:          Managing ear wax in adults
• Last review:         August 2024
• Expiry Date:         August 2026

What is ear wax?

The skin on the outer part of the ear canal has special glands that produce ear wax, also known as cerumen. The purpose of this natural wax is to protect the ear from damage and infections.

Wax is formed in the outer part of your ear canal near the external opening and not in the deep part near the eardrum.

Normally a small amount of wax accumulates and then dries up and falls out of the ear canal, carrying unwanted dust or sand particles with it.

Ear wax is helpful to coat the skin of the ear canal, where it acts as a temporary water repellent. The absence of ear wax may result in dry, itchy ears and even infection.

Most of the time the ear canals are self-cleaning; old ear wax is constantly being transported from the deeper areas of the ear canal out to the opening where it usually dries, flakes and falls out.

When should ear wax be removed? 

Under ideal circumstances, you should never have to clean your ear canals. However, we all know that this is not always the case and sometimes removal of ear wax is necessary.

Excessive ear wax may build up in the ear canal for many reasons including:

• Narrowing of the ear canal resulting from infections or diseases of the skin, bones, or connective tissue
• Production of a less fluid form of ear wax (more common in older people due to ageing of the glands that produces ear wax)
• Overproduction of ear wax in response to trauma or blockage within the ear canal.

When wax has accumulated so much that it blocks the ear canal and affects your hearing, a nurse or doctor may have to:

• Wash it out (known as irrigation)
• Micro suction it
• Remove the wax with special instruments.

Initially, a doctor may recommend ear drops designed to soften the wax; you may buy these over the counter from a pharmacy.

You should consult a doctor if you are uncertain whether or not you have a perforation (hole) in your eardrum, as putting ear wax softeners in the ear may cause an infection in the middle ear if you have a perforated eardrum. Similarly, irrigating the ear in the presence of a perforation may start an infection.

Some people may also be hypersensitive to products designed to soften ear wax. You should stop using these drops if pain, tenderness or a local skin rash develops.

Is it ok to use cotton buds?

Never put anything smaller than your elbow in your ear!

When a doctor or nurse sees wax pushed up against the eardrum, they know that it is often because the patient has been probing their ear with items such as cotton buds, hair pins or twisted napkin corners. Such objects can push the wax deeper into the ear and lead to problems.

Doctors see many perforated eardrums as a result of the above efforts.

What if ear wax builds up and causes symptoms?

Ear drops

Ear drops alone will often clear a plug of ear wax. You can buy drops such as olive oil ear drops from pharmacies.

Warm the drops to room temperature before using them (let the bottle stand in the room for about half an hour).

How do I use the drops?

Olive oil ear drops alone can often clear a plug of ear wax if used regularly. The advised method for inserting the drops is by using a dropper - the pharmacist can advise if required.

1. Lie down on your side with the affected ear uppermost.
2. Drop two or three drops of oil that is at room temperature into the ear canal.
3. Remain lying down for five minutes and then get up and wipe away any excess oil with cotton wool. Do not leave cotton wool at the entrance of your ear. This may cause the oil to soak into the cotton wool instead of into the wax, or the cotton wool may lodge in your ear and be difficult to remove.
4. Repeat the steps one to three with the other ear if needed.

Using the drops correctly will soften the ear wax. It often breaks up if put drops in twice a day for at least seven days, although you may need longer.

Flakes or crusts of ear wax often fall out bit by bit.

Ear irrigation (previously called ear syringing)

Ear irrigation is usually painless and may be needed if ear drops alone are not enough.

A health professional irrigating the ear with water will usually clear plugs of ear wax. This only works if the plug of earwax has been softened. Therefore, use ear drops (olive oil ear drops) to soften wax twice a day for at least 7 days prior to irrigation.

A machine will be used to squirt lukewarm water into your ear canal at the right pressure. This dislodges the softened plug, which then falls out with the water.

Micro suction of the ear

Micro suction is usually painless.

• To undergo ear micro suction, you must be able to move yourself onto and off the examination bed and be able to lie on your back
• You will be asked to lie on your back with your head in a slightly tilted position
• A small cone will be placed in your ear to give the nurse a clear view of your ear canal
• A small metal tube will be carefully placed into your ear to allow the wax to be removed using suction. The suction will make a “windy” noise
• Please try to keep still during the procedure
• Wax and debris will be carefully removed. On some occasions it may be necessary to use small instruments to ensure all the ear wax is removed; the ear care nurse/community nurse will discuss this with you if required.

Micro suction can only be undertaken in a clinic setting with specialist equipment and a specially trained nurse or doctor.

Side effects of ear irrigation and micro suction

You may feel dizzy after ear irrigation/micro suction, but this quickly settles. Some people develop an inflammation in the ear canal following ear irrigation. This causes itching and discomfort but can be treated with ear drops. Rarely, ear irrigation can cause damage to the ear or eardrum. The risk of this occurring with micro suction is less.

You should see a doctor or nurse if you develop ear pain, a troublesome itch, discharge from the ear or swelling of the tissues around the ear canal after ear irrigation/micro suction, as this may indicate infection.

Ear irrigation and micro suction may not be advised if you have certain ear problems, such as:

• Complications following this procedure in the past
• Ear surgery in the past (apart from grommets that have come out at least 18 months previously and you have been discharged from the hospital ear department)
• A cleft palate (even if it has been repaired)
• Have, or have had, a perforated ear drum
• An ear infection or if have had an ear infection in the previous six weeks
• Recurring infections of the ear canal (recurring otitis external).

If ear irrigation or micro suction does not work, or is not advised, you may be referred to an ear specialist for removal of troublesome ear wax.

Can I prevent a build-up of ear wax?

Some people are troubled by repeated build-up of ear wax and require ear irrigation every so often. In this situation, to prevent earwax building up and forming a plug, some doctors recommend using ear drops regularly, such as olive oil ear drops.

However, the frequency depends very much on the amount of wax produced. This could be monthly or weekly for someone prone to excessive wax production. The oil will help to keep the wax soft which helps with removal.

Therefore, if you are troubled by regular plugs of ear wax, you may wish to try using ear drops on a regular basis to see if this prevents the problem. This should only be done if you have an intact eardrum and there are no other known problems with your ears.