Impacted ear wax: causes, signs and treatment

Impacted ear wax is wax that has collected and hardened in the ear canal until it blocks it, sometimes pressing right up against the eardrum. It typically makes one ear sound muffled and feel full. It isn't dangerous and it is very treatable: softening drops clear some plugs on their own, and a trained clinician can remove the rest, usually in one appointment.

What is impacted ear wax?

Ear wax normally looks after itself. It is made near the entrance of the ear canal, and the skin lining the canal slowly carries it outwards until it dries and falls away. Most of the time you never notice this happening.

Wax becomes impacted when that process stalls. Instead of moving out, it gathers, packs down and hardens into a plug. The medical name is cerumen impaction, and you will find it and other terms explained in our ear care glossary.

Not every build-up counts. A clinician may see a fair amount of wax in an ear that hears perfectly well, and that wax can be left alone. NICE guidance recommends removing wax when it is contributing to hearing loss or other symptoms, or when it has to come out so that someone can examine the ear or take an impression for a hearing aid.

What causes ear wax to become impacted?

There are two broad reasons: something keeps pushing the wax back in, or the ear doesn't clear it as well as it should. Often it is a bit of both.

• Cotton buds, fingers and hairgrips. They remove a little wax from the entrance and shove the rest further down, into the narrower bony part of the canal where it can't get out. Read why cotton buds make ear wax worse.
• Things you wear in your ears. Hearing aids, earplugs and in-ear headphones block the way out and nudge wax back every time they go in. See our guide to ear wax and hearing aids.
• The shape of your ear canals. Narrow, very curved or damaged canals give wax less room to move. So do bony growths called exostoses, sometimes known as surfer's ear.
• Hair in the ear canals, which becomes thicker with age and holds wax back.
• Age. Wax gets drier and harder over the years, and older skin moves it along less efficiently.
• Skin conditions such as eczema or psoriasis in or around the ear, which add more shed skin to the mix.

Some people simply make more wax, or wax of a stickier kind, and block again and again despite doing nothing wrong.

Symptoms of impacted ear wax

A plug can build up for months without causing any trouble, because a thin gap is enough to let sound through. Symptoms tend to arrive when that gap closes, often overnight after a shower or swim, when water makes the wax swell.

These overlap with other ear problems, which is why it helps to have the ear looked at rather than assume. Our guide to the signs of ear wax build-up goes through each symptom in more detail, and there are separate guides on ear wax and tinnitus and ear wax and dizziness.

Can impacted ear wax clear on its own?

Sometimes, with help. Softer plugs often shift after a few days of drops, and it is always worth trying them first unless you have a reason not to.

The NHS suggests lying with the affected ear facing up and putting 2 to 3 drops of medical grade olive or almond oil into it, 3 to 4 times a day for 3 to 5 days. A pharmacist can suggest alternatives, such as drops containing sodium bicarbonate or urea hydrogen peroxide, which help to break the wax down. Some people find those more irritating than oil. Our guide on how to use ear drops explains how to get them where they need to go.

Hard, long-standing plugs are more stubborn. Drops may soften the surface without reaching the middle, and some people end up needing the plug removed whatever they try at home.

If your symptoms haven't cleared after 5 days of drops, or the ear is so blocked you can't hear anything, the NHS advises seeing a nurse at your GP surgery. Not every surgery still offers wax removal, though. Our guide to ear wax removal on the NHS explains what is available and what to do if your surgery says no.

How clinicians remove impacted wax

Whether you go through the NHS, a pharmacy or a private clinic, the appointment follows much the same pattern.

1. Questions and a look in the ear. The clinician asks about past ear surgery, grommets, a perforated eardrum, infections and any pain or discharge, then looks in with an otoscope, microscope or camera to confirm it is wax.
2. Choosing the method. Microsuction suits most people, including those who can't have water in the ear. Irrigation works best on wax that has already been softened. Very hard or awkward pieces may be lifted out with a fine instrument.
3. Removing the plug. Wax comes out in stages, with pauses if you feel dizzy or uncomfortable. A stubborn plug may need a few more days of drops and a second visit.
4. A final look and advice. Once the wax is out, the clinician looks at the canal and eardrum, tells you what they found and explains how to look after your ears for the next few days.

The three main methods are microsuction, where a fine suction tube lifts the wax out under magnification; electronic ear irrigation, which washes softened wax out with a controlled flow of warm water; and manual removal with a small curette or hook. NICE advises against the old hand-held metal syringe. Irrigation isn't used if you have a perforated eardrum, grommets, recent ear surgery or an active infection, so microsuction is often the choice for those ears.

Our comparison of microsuction and ear irrigation sets out the pros and cons of each, and what happens at an ear wax removal appointment walks through a typical visit from start to finish.

Stopping impacted wax coming back

You can't stop your ears making wax, and you wouldn't want to. You can make a repeat blockage less likely, though.

Keep cotton buds and fingers out of your ear canals and clean only the outer ear with a flannel. If you wear hearing aids or earbuds for hours at a time, clean them regularly and give your ears a break when you can. The NHS says that using olive oil or ear drops regularly helps keep wax soft enough to fall out by itself, and people who block often are sometimes advised to do this between appointments. A pharmacist or the clinician who treats you can suggest how often.

If you find you need wax removed every few months, our guide on how often to have ear wax removed will help you find a sensible routine, and what ear wax removal costs in the UK covers private prices.