Ear wax (cerumen) protects the ear canal by trapping dust, repelling water, and providing lubrication. The ear is generally self-cleaning, moving older wax toward the outer ear where it naturally falls out. For some individuals, however, this process fails, leading to an accumulation known as impaction. This buildup can cause uncomfortable symptoms such as a feeling of fullness, temporary hearing impairment, ringing in the ears (tinnitus), or pain, necessitating professional removal.
Primary Care Providers and General Practitioners
A primary care provider, such as a family physician or general practitioner, is often the first and most accessible option for addressing mild to moderate cases of ear wax buildup. The most common method used in this setting is electronic water irrigation, sometimes still referred to by the outdated term syringing.
This procedure involves using a controlled, low-pressure stream of warm water to flush the wax out of the ear canal. Before the procedure, the patient is often advised to use over-the-counter softening drops for a few days to soften the wax. A primary care physician may choose to refer a patient elsewhere if they have a history of a perforated eardrum, recent ear surgery, or an active ear infection, as water irrigation is contraindicated due to the risk of complications.
Specialized Care from ENTs and Audiologists
Specialized care becomes necessary when a case is complex, recurrent, or involves a contraindication for water irrigation. Otolaryngologists (ENT physicians) and audiologists are the professionals who perform advanced removal techniques. ENTs are medical doctors who diagnose and treat ear conditions, while audiologists specialize in hearing and balance disorders and are often trained in wax removal.
These specialists often use techniques that allow for direct visualization of the ear canal. Micro-suction is considered the preferred technique, which uses a fine, sterile suction device to gently vacuum the wax out of the ear canal under the guidance of a microscope or specialized loupes. This dry method is safer for patients with a history of eardrum perforation, previous ear surgery, or those who wear hearing aids, as it avoids introducing moisture into the ear.
Another manual technique is curettage, where the specialist uses a small, spoon-shaped instrument called a curette to physically scoop out the wax under magnification. Referral to an ENT is necessary for severely impacted wax, when primary care attempts have failed, or if the patient has a narrow or irregularly shaped ear canal. Audiologists and ENTs also work together to ensure the ear canal is clear before a hearing test or the fitting of a hearing device.
Addressing At-Home Methods and Safety Warnings
While professional care is recommended for impaction, many people attempt to manage ear wax at home using potentially harmful methods. The most common practice is the use of cotton swabs, which typically push the cerumen deeper into the ear canal, causing impaction and potentially leading to temporary hearing loss. Inserting any object, including bobby pins or twisted paper, risks damaging the delicate skin of the ear canal or puncturing the eardrum.
Another unsafe practice is ear candling, which involves lighting a hollow cone placed in the ear canal. Health authorities warn against ear candling due to the risk of serious injuries, including burns to the face and eardrum, or blocking the ear canal with dripping candle wax. The safest approach for at-home management is the use of over-the-counter softening drops, such as those containing carbamide peroxide, to help the wax naturally migrate out of the ear. If symptoms of blockage persist after using softening drops for four days, a medical professional should be consulted for safe removal.