Ear wax is not dirt, and a build-up is not a sign that you have failed to clean your ears. It is made deliberately by glands in the outer third of the ear canal, and it does a job. It traps dust and debris, it stops the skin of the canal drying out, and it creates a slightly acidic surface that discourages bacteria and fungi.
Most people never need to think about it. The canal is self-cleaning, and jaw movement from talking and chewing slowly carries old wax outwards until it falls away unnoticed. Problems start when that process fails, or when something interferes with it.
What causes ear wax to build up
How much you produce is largely genetic. Some people simply make more wax than others, and there is nothing to be done about that. If your parents needed their ears cleared regularly, there is a fair chance you will too.
The shape of your ear canal matters. Narrow canals, sharply bent canals and canals with a lot of hair are all harder for wax to leave. This is part of why build-up becomes more common with age. Ear hair tends to coarsen, and wax gets drier and less mobile.
Cotton buds are the most common avoidable cause. A cotton bud takes a little wax from the entrance and pushes the rest deeper, past the narrowest part of the canal, where the self-cleaning mechanism cannot reach it. Over months that produces a firm plug sitting against the eardrum. The same applies to hair grips, matchsticks, keys and everything else people put in their ears.
Anything worn in the ear has a similar effect. In-ear headphones, especially the sealing noise-cancelling type, along with hearing aids, ear plugs and hearing protection, all act as a stopper. They hold wax in, and the contact itself stimulates the glands. People who wear hearing aids all day are among the most frequent users of a wax removal service. That is not a criticism of hearing aids, it is simply what happens.
Skin conditions change the picture. Eczema, psoriasis and seborrhoeic dermatitis in the canal produce extra scale, which mixes with wax and makes it harder and stickier. Recurrent infection does the same.
Dusty or dirty environments irritate the canal, and irritation increases wax production.
The symptoms worth acting on
Wax rarely causes anything dramatic until the canal is nearly blocked, which is why people are often surprised by how much comes out. The usual symptoms are:
- Muffled or reduced hearing, often in one ear only
- A feeling of fullness or pressure, as though the ear needs to pop
- Earache, or a dull ache deep in the canal
- Tinnitus, usually a ringing or humming that was not there before
- Itching in the canal
- Dizziness or unsteadiness
- A cough, which happens because wax pressing on the canal wall stimulates a branch of the vagus nerve
- A hearing aid that has started whistling or cutting out
Hearing that comes and goes, or that drops suddenly after a shower or a swim, is very suggestive of wax. Water swells a partial plug into a complete one.
One important caveat. Sudden hearing loss in one ear is not always wax. Sudden sensorineural hearing loss is a medical emergency and needs treating within days. If your hearing drops suddenly and there is no obvious reason, do not assume it is wax and wait it out. Get it looked at.
When wax becomes impacted
Impacted wax is wax that has hardened and filled the canal to the point where it will not clear on its own. It is not a different substance, just the same wax left long enough to dry out and compact.
Impaction produces the more uncomfortable symptoms: the throbbing ache, the tenderness around the ear, the persistent tinnitus. It also stops anyone examining the eardrum, which matters more than people realise. A doctor who cannot see your drum cannot tell you whether your ear pain is wax, an infection, or something else entirely.
Why it is worth dealing with
Hearing loss. Wax is one of the few completely reversible causes of hearing loss. Clearing it takes minutes and the hearing usually returns straight away.
Infection. Wax normally protects against infection. A large plug does the opposite, because it traps moisture and debris behind it. This is why swimmer’s ear so often follows a holiday in someone who already had a lot of wax.
Balance and falls. Wax pressing on the eardrum can affect balance. In an older person, unsteadiness is not a minor complaint.
Hearing and cognitive health. Untreated hearing loss in midlife is one of the largest modifiable risk factors for later dementia, on the Lancet Commission’s analysis. That evidence concerns permanent hearing loss, not wax. The practical point still holds: if part of your hearing loss is wax, that is the part you can fix, and it is worth fixing before deciding whether you need a hearing aid.
Getting a straight diagnosis. Anyone assessing your ears, your hearing or your balance needs to see the eardrum first.
When to get it seen
Get it looked at if your hearing is reduced, your ear has felt blocked for more than a few days, you have new tinnitus, or you are in pain. If it has already been there a fortnight, it is not going to clear itself.
Softening drops, olive oil or sodium bicarbonate, used for a few nights, will help a mild build-up. They will not shift a firm plug, and they can make things briefly worse by swelling the wax. There is more on this in our guide to preventing ear wax build-up.
Do not try to remove it yourself. Nothing sold for home use will safely remove impacted wax, and the skin of the canal is thin, easily torn and slow to heal.
How we treat it
At Ear Care Lab we remove wax by microsuction, under a binocular operating microscope, using no water and needing no drops beforehand. Every procedure is carried out by a doctor. Our team are all GPs with a specialist interest in ENT, so if the problem turns out not to be wax, we can diagnose and treat what is actually going on.
Appointments are £75 for one or both ears, adults and children alike, and usually take 15 to 30 minutes. Same-day slots are often available, including for emergency ear wax removal. If you want the evidence behind why we use microsuction instead of syringing, we have set it out in ear syringing versus microsuction.
Book an appointment online, or call us on 0208 004 7808.
