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Earwax

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Overview

Earwax is the result of cerumen, sebum, sweat, dead cells, dust etc. building up and is normally secreted in the ear and has a protective role. Accumulations of earwax and impaction can lead to problematic symptoms.

Epidemiology

More common in:

  • The elderly
  • Cotton bud use
  • Hearing aid use

Risk Factors

  • Increasing age or <5 years
  • Male sex
  • Down’s syndrome
  • Cotton bud use
  • Hearing aid use

Presentation

The main presenting complaint is hearing loss. Other features may be:

  • The sensation of the ear being “full”
  • The hearing loss is conductive
  • Tinnitus
  • Vertigo
  • Earache and discomfort

Differential Diagnoses

Otitis externa

  • Tenderness of the tragus and pinna, movement of these is usually painful
  • The ear canal may be erythematous
  • Otorrhoea may be present

Investigations

  • None – clinical diagnosis
  • Consider an audiogram for persisting hearing loss after treatment

Management

All patients

  • 1st-line: olive/almond oil eardrops or sodium bicarbonate eardrops
  • Consider ear irrigation or microsuction

Monitoring

  • After treatment, patients should have their ears examined to ensure there are no remaining problems within the ear that might have been obstructed by the earwax e.g. a perforated tympanic membrane

Patient Advice

  • Do not use cotton buds, these can push wax further in and impact it, damage the ear canal, and perforate the tympanic membrane
  • Patients should be safety-netted on the signs of infection and should return should they arise e.g. infection, significant ear pain/itching, discharge, or swelling

Complications

  • Hearing loss
  • Earache
  • Increased risk of infection e.g. otitis externa
  • Stress

Prognosis

  • In some patients, the problems may recur as they may be prone to producing excess earwax

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