Earwax build-up

The ear does not need cleaning out. Wax is not dirt but the working lubricant of the ear canal: it is acidic, so germs do badly in it, it traps dust and it stops the skin drying out. Normally it leaves on its own, because the skin of the canal grows slowly outwards from the eardrum and carries everything surplus with it, like a conveyor belt. Trouble starts when that mechanism falters — or when somebody decides to "help" it along with a cotton bud. The wax then packs down into a plug and the ear goes deaf. That in itself is not dangerous, but in this subject something else matters more: very similar words are used to describe situations that cannot wait.

What a plug of wax feels like

The complaints are almost always the same:

• a blocked ear, muffled sound, your own voice booming inside your head;
• hearing that has dropped, usually gradually, though sometimes abruptly after a shower or a swim, when wax swollen by water closes the last gap that was left;
• noise or ringing, generally on one side;
• itching, a feeling of fullness, occasionally a dull ache;
• a dry nagging cough with no cold to explain it — the skin of the canal carries a branch of the vagus nerve, and pressure on it sets off the cough reflex;
• a hearing aid that has begun to whistle or sit less well; for anyone who wears one, that is usually the first sign of all.

Dizziness from wax does happen, but it is uncommon and usually mild. If it is severe, with vomiting and no chance of standing up, wax is not the explanation.

What cotton buds, candles and "vacuums" actually do

A cotton bud is almost exactly the diameter of the ear canal. It does not scoop wax out; it works as a piston, bringing a small amount to the surface and ramming the bulk of it deeper, to where the canal narrows and from where wax can no longer make its own way out. On the way it scratches very thin skin and strips off its protective layer, which is precisely how an outer ear infection begins. The same goes for hairgrips, matches, pen lids and your own finger.

Ear candles deserve a paragraph of their own. The hollow tube burnt above the ear creates no suction whatever; the dark residue displayed afterwards is the wax of the candle itself. What has been described, more than once, is burns to the outer ear, drops of molten wax on the eardrum and perforation of it. The domestic ear "vacuums" sold online do no better: their suction is not equal even to soft wax.

What can genuinely be done at home

There is one home strategy: soften the wax, then let the ear carry it out itself.

• Lie on your side with the affected ear uppermost. Put in a few drops of warm — room temperature — olive or almond oil, or a pharmacy preparation for dissolving wax. Almond oil is not used by anyone with a nut allergy.
• Stay like that for five to ten minutes, then wipe away on the outside with cotton wool whatever has run out.
• Repeat two or three times a day for several days running. The lumps usually come out by themselves over about two weeks.
• Oil straight from the fridge should not go in: a sudden temperature change inside the canal causes dizziness.
• Hearing may get worse for a while after the drops, because softened wax spreads out and fills whatever gap was left. That is normal and passes.

There are situations in which nothing goes in at all: a hole in the eardrum, a grommet in place, previous ear surgery, an active inflammation with pain or discharge. If you do not know whether your eardrum is intact, do not use drops — ask. Nor is it a good idea to wash the ear out at home with a syringe or the shower head: a jet under pressure tears an eardrum far more easily than people imagine.

When wax is not the answer

This is the most important section. Wax is a convenient culprit, and time gets lost because of it.

• Hearing goes suddenly, over minutes or hours, in one ear, with no pain and no preceding blockage. Wax does not behave like that; it builds over weeks. Sudden sensorineural deafness responds better the earlier it is treated, and the window is measured in days. That means being seen immediately rather than dripping oil in for a week.
• One ear persistently hears worse than the other, the ringing is on that side only, and removing the wax changed nothing. One-sidedness always deserves a separate look: behind it can sit a benign tumour of the hearing nerve, which grows slowly and disguises itself as "wax" for years.
• An adult keeps blocking up in the same ear, with fluid behind the eardrum and no cold in the picture. In a child that is ordinary; in an adult it is not, and it can be how a growth at the back of the nose, obstructing the mouth of the eustachian tube, shows itself. The nose needs examining too in that case.
• The ear is discharging, especially if it smells or is bloodstained, the ear hurts, there is a fever, or the skin behind the ear is red and swollen. That is infection: it is treated, not cleaned out.
• Severe dizziness with vomiting, double vision, weakness in an arm or leg, a drooping face. At that point the question is no longer about ears: call an ambulance, in Europe on the single number 112.

How wax is removed professionally

If a week or two of oil has changed nothing, or the ear is completely blocked, the wax is taken out mechanically. There are three ways.

• Irrigation with warm water from a machine with controlled pressure. It is the commonest method and is not usually painful, but it has contraindications: a perforated eardrum, a grommet in place, previous ear surgery, a single hearing ear, an active infection. All of that has to be mentioned beforehand.
• Microsuction: wax is sucked out through a fine tube under a microscope. The canal is visible throughout, which makes it safer when the state of the eardrum is uncertain. Noisy, but quick.
• Instrument removal with a small hook or curette under direct vision, generally kept for very hard plugs and for people who must not have water in the ear.

Before any of them you will almost always be asked to use oil for two or three days: softened wax comes out in a minute, dry wax takes a long and uncomfortable while. Hearing returns immediately afterwards, sometimes with startling sharpness; a few hours of mild ringing or a damp feeling in the ear are common. If pain or discharge appears after the procedure, or hearing does not come back, go and be checked again.

Who gets it again and again

Some people accumulate wax through no fault of their own. A narrow or sharply curved canal, plenty of hair inside it, eczema and psoriasis, the changes in skin with age that make wax drier and harder, and the constant wearing of hearing aids, earplugs or in-ear headphones all interfere with the natural self-cleaning.

Wax production cannot be switched off, and there would be no point. But recurrences drop noticeably if a few drops of oil or a pharmacy preparation go in every week or two, if nothing is pushed inside, and if a hearing aid is wiped daily and its filter checked for blockage. Anyone who comes back regularly for removal is usually advised not to wait until they are deaf but to come on whatever schedule the doctor works out for them.

Online consultation

Remotely, the question people usually turn up with gets settled: does this look like wax or not, and can it be started on oil. The doctor will go through how the hearing has changed, whether there is noise, pain or discharge, whether there has been ear surgery, and what has been tried already, will explain how to put drops in properly and how long to give them, and will say which removal method suits you given the state of the eardrum. Sudden loss of hearing, pain with fever and dizziness with vomiting are not assessed through a screen — those need to be seen in person straight away.

This material is for information only and does not replace medical advice.