Cerumen, or earwax, is a naturally occurring substance produced by glands in the outer ear canal. It serves a protective function, lubricating the skin and acting as a barrier to trap dust, dirt, and foreign particles before they reach the eardrum. Cerumen also contains antimicrobial properties that help guard against infection. Typically, the ear is self-cleaning, with jaw movements helping old wax migrate out naturally. When this self-cleaning mechanism fails or wax production is excessive, the cerumen can build up and harden, requiring medical intervention.
When Professional Removal is Necessary
A cerumen impaction occurs when earwax completely blocks the ear canal, causing noticeable symptoms. Common signs include a feeling of fullness or blockage, often accompanied by muffled or reduced hearing. The blockage can press upon the eardrum, causing an earache or persistent ringing, buzzing, or humming (tinnitus).
Impacted wax can also cause dizziness or a sense of being off-balance, as the ear plays a role in equilibrium. Professional removal is necessary when symptoms persist despite over-the-counter softening drops or if the person has a history of ear problems. Individuals with a perforated eardrum, ear tubes, or recurrent ear infections should always seek professional help, as at-home methods are unsafe.
The Primary Methods of Professional Removal
Medical professionals use established and safe techniques to clear impacted earwax. The specific method chosen depends on the wax’s consistency and location, as well as the patient’s medical history. Procedures are performed under direct visualization to ensure the safety of the delicate structures within the ear canal.
Irrigation
Ear irrigation involves using a controlled stream of fluid to flush the wax out of the ear canal. Modern systems use electronic pumps to deliver a steady, low-pressure flow of warm water or a saline solution. This is an improvement over older manual syringes, which delivered inconsistent pressure.
The water is warmed to body temperature to prevent dizziness, which occurs if cold water is introduced. The stream is directed toward the wall of the ear canal, behind the wax, to gently dislodge the blockage. While highly effective for softer wax, this method is avoided if the patient has a perforated eardrum or a history of ear surgery due to the risk of moisture entering the middle ear.
Micro-Suction
Micro-suction is regarded as one of the safest and most precise methods of wax removal because it is a completely dry procedure. The practitioner uses a low-pressure medical suction device, with a fine sterile probe inserted into the ear canal. The procedure is performed while viewing the ear canal through a microscope or specialized magnifying loupes.
Direct visualization allows the practitioner to precisely target the wax without touching the ear canal walls. Since no water is used, micro-suction is the preferred technique for individuals with a perforated eardrum, mastoid cavities, or outer ear infections. The gentle, controlled suction safely siphons out the earwax, often providing immediate relief.
Manual Instrumentation
Manual instrumentation involves using specialized tools to physically remove earwax under direct, magnified vision. Instruments include small loops, hooks, or curettes, such as a Jobson Horne probe, designed to gently scrape or scoop the wax out. Forceps may also be used to grasp and extract large, hard pieces of wax.
This technique is effective for very hard, deep, or stubborn impactions that may not respond to irrigation. Because the procedure uses instruments, it requires a high degree of skill and precision from the healthcare professional. Manual removal can also be used in combination with micro-suction or irrigation to clear remaining fragments of wax.
Post-Procedure Care and Expectations
Following professional earwax removal, patients may experience temporary sensations as the ear canal readjusts. The most common is a temporary sensitivity to sound, as the ear canal is no longer muffled by the wax blockage. Some individuals may also feel mild, temporary dizziness, particularly after irrigation, though this usually resolves quickly.
It is important to monitor the ear for signs of infection for a few days following the procedure. Persistent or worsening pain, unexpected discharge, redness, or swelling should prompt an immediate call to the healthcare provider. To promote healing, patients are advised to avoid inserting anything into the ear canal, including cotton swabs, which can push wax deeper or cause injury.
Preventative care involves keeping the ears dry for a short period, especially after irrigation, and gently wiping the outer ear with a clean cloth. For people prone to recurrent impaction, the doctor may recommend using over-the-counter ear drops periodically to soften the wax. Regular check-ups help manage chronic wax buildup, ensuring the ear’s natural self-cleaning process remains unimpeded.