Ear Wax removal
Ear wax — also known as cerumen — is a normal and helpful substance produced by the ear canal. It protects the canal skin, lubricates it, and carries debris, dead skin cells, and bacteria outward as part of the ear’s natural self-cleaning process. In most people, most of the time, ear wax does not need to be removed. When it does cause problems, there are several safe and effective ways to address it — and several approaches that should be avoided.
What Is Ear Wax?
Ear wax is produced by two types of small glands in the outer ear canal — ceruminous and sebaceous glands — along with shed skin cells and fine hairs. The secretions contain proteins and fats that help protect the canal skin from infection and dryness.
The appearance of ear wax varies between individuals and populations. In people of European background it tends to be yellow or brown and moist — what is sometimes called wet ear wax. In people of Asian background it is more commonly grey, dry, and flaky — dry ear wax. This difference is genetic. In older men with hair around the entrance to the ear canal, wax can also collect hair, making it more difficult to migrate naturally. Ear wax generally becomes drier and flakier with age.
What Does Ear Wax Do?
The skin lining the ear canal and eardrum is constantly renewing itself. Old skin cells migrate outward from the eardrum toward the opening of the canal — a conveyor belt process that is unique to the ear canal. Ear wax travels with these cells, carrying trapped debris, insects, bacteria, and other material out of the canal in the process.
Ear wax also lubricates the canal skin, preventing itchiness, dryness, and a burning sensation — symptoms that often appear in people who clean their ears too aggressively and strip the canal of its protective coating. It provides a physical and chemical barrier against both bacterial and fungal infection.
When Does Ear Wax Cause Problems?
When wax accumulates faster than the natural migration process can clear it, or when migration is disrupted, wax can become impacted — blocking the canal and causing symptoms. These include hearing loss, a sensation of fullness or blockage in the ear, autophony (hearing your own voice abnormally loudly when speaking), and tinnitus. If water becomes trapped behind impacted wax — after swimming or showering — a painful outer ear infection (otitis externa) can develop.
Hearing aids are a particular contributor to wax impaction. They interfere with the natural outward migration of wax, and up to 80% of hearing aid faults are attributed to wax accumulation in or around the device.
Cotton Buds — Why They Should Never Be Used
Cotton buds are responsible for a large number of ear canal problems and should never be placed in the ear. In most cases they do not remove wax — they push it further into the canal, compacting it against the eardrum. Inserted too far, they can perforate the eardrum. By removing the superficial wax layer that protects the canal skin, regular cotton bud use can lead to recurrent infections, itchiness, and dryness — the very symptoms people are trying to prevent.
The ear canal does not need to be cleaned with cotton buds. If you stop using them, your ears will generally be healthier.
Ear Wax Removal — Options
Wax Softening Drops
Commercial wax softening preparations — including Waxsol, Cerumol, and Earclear — are useful for softening impacted wax and aiding its removal. They may need to be used for several days in cases of significant impaction. If you are planning to see a GP or specialist for wax removal, using softening drops for five days beforehand (three times daily) will make the procedure easier and more comfortable — softer wax is significantly easier to remove than hard, dry wax.
A simple and effective option available without prescription is 3% hydrogen peroxide, available from most pharmacies and supermarkets. Draw a small amount into a 3 or 5mL syringe, instil it into the ear canal, and allow it to bubble for approximately one minute before draining. This can be repeated several times daily. It is safe to use in the presence of a perforated eardrum, an ear infection, or in a child with grommets.
Ear Irrigation
Ear irrigation — flushing the canal with warm water — can be effective when performed correctly. The ear should be held slightly backward and upward, with the irrigating nozzle angled to allow water to flow in above the wax and drain out below it. Warm water is more comfortable than cold — cold water in the ear canal can cause temporary vertigo.
Irrigation is not without risk. If the procedure is painful it should be stopped immediately. Water that is applied too forcefully can perforate the eardrum. In cases of dense impaction, water may be unable to flow behind the wax at all. Trapped water behind impacted wax can trigger an outer ear infection. The canal should always be inspected after irrigation to confirm complete removal.
Irrigation is not appropriate for all patients. Those with a history of ear surgery, a perforated eardrum, or recurrent ear infections should discuss the most appropriate removal method with a clinician before proceeding.
Microsuction and Instrumentation
Microsuction is the technique used by otolaryngologists (ENT specialists) and trained audiologists. The ear canal is examined under a microscope or with a video otoscope, and fine suction instruments are used to remove wax under direct vision. No water or irrigation is required. The procedure is precise, comfortable, and carries no risk of water-related complications. Occasionally, small smooth instruments are used to gently loosen very dry or adherent wax before suction. In cases of dense impaction, wax softening drops for several days prior will make the procedure faster and more comfortable.
A Note on Ear Candling
Ear candling is an alternative medicine practice that involves placing a lit hollow candle near the ear canal. It is ineffective and dangerous. Studies have demonstrated that ear candles generate no negative pressure and have no ability to draw wax from the canal — and in some cases deposit wax or debris rather than removing it. Burns and other injuries have been reported. Ear candling should not be performed.
Seely DR, Quigley SM, Langman AW. Ear candles — efficacy and safety. The Laryngoscope. 1996;106(10):1226–9.
Ear Wax Removal at Dr Roth’s Practice
Wax removal at Dr Roth’s practice begins with a consultation to review any history of ear disease, surgery, trauma, or current ear symptoms. You are seated in a reclining chair with a headrest while a microscope is positioned to give a magnified view of the canal. Fine sterile suction is used to remove wax gently and carefully, without water or pressure. The eardrum is inspected once wax has been cleared. Small smooth instruments may be used to loosen adherent wax where necessary. The procedure is well tolerated and generally causes no pain.
In cases of very dense impaction, all wax may not be removable in a single sitting — wax softening drops used for a few days afterwards allow the remaining wax to be cleared at a follow-up visit.
Dr Roth also recommends ear wax removal by his audiologists at Northern Beaches Audiology for patients who prefer an audiology-based service or require an appointment at shorter notice.
Dr Roth’s Clinical Perspective
Ear wax is probably the most common reason people present to an ENT practice with an ear complaint, and the most common piece of advice I give is to stop using cotton buds. The damage caused by regular cotton bud use — pushed-in wax, stripped canal skin, recurrent infections — accounts for a significant proportion of the ear canal problems I see. The ear canal cleans itself. It does not need assistance from cotton buds, and attempts to help almost always make things worse.
For patients who do accumulate wax and find it causing problems, microsuction is the most controlled and comfortable removal technique available. The combination of direct vision under the microscope and fine suction instruments means the procedure is safe even in patients with a perforation, previous surgery, or a history of ear infections — situations where irrigation should not be used. If you are considering wax removal and have any of those factors in your history, it is worth seeking microsuction rather than irrigation.
— Dr Jason Roth, MBBS, FRACS (ORL-HNS)
Specialist Otolaryngologist & Head and Neck Surgeon
Specialist registration — Otorhinolaryngology, Head & Neck Surgery
View full profile
