Hearing loss is a common problem that affects people of all ages. One potential cause of hearing loss is a buildup of earwax in the ear canal. Earwax, also known as cerumen, is produced by glands in the outer part of the ear canal and helps protect and clean the ear. However, too much earwax can cause blockage of the ear canal and temporary hearing loss. Removing excess earwax is often recommended as a way to improve hearing.
What is earwax?
Earwax is a yellowish waxy substance secreted by special glands in the outer part of the ear canal. It is designed to trap dust and other small particles to prevent them from reaching and potentially damaging the eardrum. Earwax also contains substances that inhibit the growth of bacteria and fungi. So in normal amounts, earwax is beneficial.
Earwax is produced by two types of glands in the ear canal – sebaceous glands and ceruminous glands. Sebaceous glands secrete an oily substance, while ceruminous glands secrete a dry, flaky substance. The combination of the oily and dry secretions makes up the wax-like cerumen.
Earwax is normally expelled from the ear naturally through jaw movement. The wax slowly migrates outwards and eventually falls out of the ear or is removed when washing. In most people, the self-cleaning process works well to remove excess earwax.
What causes earwax buildup?
While earwax is normal, some people produce excessive amounts which can lead to blockage and hearing loss. Common causes of earwax impaction include:
- Overproduction of earwax – Some people simply produce more wax than others
- Narrowing of the ear canal – Obstructing growths or ear canal deformities can trap wax
- Use of hearing aids or earplugs – These can push wax deeper into the ear canal
- Older age – Earwax becomes drier and harder with aging
- Hairy ear canals – More hair results in more wax production
- Dry, flaky skin conditions – These increase wax buildup
- Improper ear cleaning – Using cotton swabs can push wax deeper
Certain medical conditions and medications can also increase earwax accumulation. Earwax impaction is especially common in older adults due to age-related changes in glandular activity and stiffening of the ear canal skin.
How does earwax cause hearing loss?
The accumulation of earwax in the ear canal can cause different types of hearing loss:
- Conductive hearing loss – This occurs when excess wax physically blocks sound from passing through the outer and middle ear. The tympanic membrane (eardrum) and ossicles (tiny middle ear bones) work normally, but the blockage prevents sound waves from reaching them.
- Sensorineural hearing loss – A complete earwax blockage can put damaging pressure on the eardrum and inner ear structures. This can cause sensory hair cells in the cochlea to die off, resulting in permanent nerve deafness.
- Mixed hearing loss – In some cases both conductive and nerve deafness can result from severe, chronic earwax impaction.
The severity of hearing loss depends on the degree of blockage. Partial impaction can muffle sounds, while complete blockage can cause up to 40-decibel conductive hearing loss. Unilateral blockage affects only one ear, while bilateral blockage affects both.
How is earwax impaction diagnosed?
If earwax buildup is suspected, a physician will usually examine the ear using an otoscope – a device that magnifies and illuminates the ear canal. Signs of excess earwax include:
- Visible wax occlusion
- Dullness, opacity or yellow/brown discoloration of the eardrum
- Feeling of fullness or discomfort in the ear
- Coughing when the outer ear is touched or manipulated
- Hearing loss or ringing/noise in the ear
An audiogram, which measures hearing thresholds at different sound frequencies, can confirm the degree of conductive loss caused by the blockage. Imaging scans like CT or MRI may be done to evaluate for underlying problems with the ear canal anatomy.
How is earwax removed?
Removing excess earwax can be performed at home or by a healthcare professional. Here are some common methods of earwax removal:
At-home treatments
- Earwax softening drops – These contain ingredients like carbamide peroxide or glycerin to break up wax.
- Irrigation – Using a rubber-bulb syringe or powered irrigator to flush water into the ear.
- Cerumenolytic agents – Substances like mineral oil or hydrogen peroxide help loosen wax.
- Ear candling – A hollow candle is inserted in the ear canal and lit, creating suction to remove wax. Not recommended due to safety concerns.
Professional procedures
- Manual removal – The health professional uses an instrument called a curette to scoop out earwax under direct visualization.
- Microsuction – A small suction tip is inserted into the ear to suck out softened wax.
- Irrigation – Warm water or saline is flushed into the ear using a controlled suction-irrigation device.
- Debridement – Removing stubborn wax using an operating microscope and specialized instruments.
After wax removal, antibiotic ear drops may be prescribed for several days to prevent infection. Removing wax is generally painless, but the ear may feel irritated for a short time afterwards. Serious complications like eardrum perforation are very rare.
Does earwax removal help hearing?
Yes, removing excess earwax commonly leads to improved hearing:
- Complete blockages – Hearing typically returns to normal once the obstruction is relieved.
- Partial blockages – Hearing partially improves but may not become totally normal.
- Long-standing blockages – Hearing recovery may be limited if the blockage persisted for a long time.
The prognosis depends on how quickly the wax is removed once hearing loss is noticed. After wax is eliminated, hearing should be rechecked to determine if any permanent damage occurred. Timely removal of earwax is the best way to optimize hearing recovery.
Does earwax return after removal?
Yes, earwax production resumes as normal following removal. However, it may take several weeks for wax to re-accumulate to problematic levels after a thorough ear cleaning. Some people are prone to recurrent earwax impaction and require more frequent removal interventions. Steps to prevent excessive buildup include:
- Avoiding insertion of objects like cotton swabs into the ear canal
- Applying olive oil drops to soften wax
- Having regular hearing check-ups to catch buildup early
- Using earplugs sparingly if they tend to push wax deeper
- Trying over-the-counter wax softeners
- Getting professional cleaning done annually if prone to blockages
If frequent wax blockages occur despite preventive efforts, a doctor may recommend prescription-strength eardrops or more aggressive irrigation methods.
When should you see a doctor?
See a doctor or audiologist if you experience:
- Visible wax occlusion or buildup when looking in the ears
- Pain, discomfort, itching or discharge in the ear
- Feeling of fullness, popping, or ringing in the ears
- Dizziness or balance problems
- Decreased hearing or sounds seeming muffled in one or both ears
- Ongoing earwax problems despite home removal efforts
Professional cleaning should also be done for people who have diabetes, bleeding disorders, ear deformities, or a history of ear surgery. Trying to remove wax on your own can sometimes make the impaction worse.
When to avoid earwax removal
Earwax removal should not be performed if you have any of the following conditions:
- Active drainage or infection of the ear – This requires medical treatment first.
- Presence of a perforated eardrum
- Previous ear surgery like mastoidectomy
- Otitis externa with severe swelling of the ear canal
- Presence of a tube in the eardrum
Removal should be avoided in these situations due to the risk of complications like pain, infection, and further injury to the ear structures. The safest approach is to let a doctor evaluate the ear first before proceeding with wax extraction.
Risks and complications
For most people, earwax removal is a safe procedure with few risks. However, potential complications can include:
- Ear discomfort or irritation – From instrumentation of the ear canal
- Infection – Improper technique can introduce bacteria; preexisting infection can worsen
- Tinnitus – Discomfort during removal can cause temporary ringing in the ear
- Dizziness – Irrigation can stimulate the vestibular system and cause imbalance
- Eardrum perforation – Especially if tools are used too aggressively into a blocked canal
- Bleeding – Blood vessels may be damaged in the canal, especially in elderly patients
- Hearing loss or acoustic trauma – From harsh irrigation or mechanical scraping
These risks are reduced by having an experienced professional perform the wax extraction with caution and care. Proper post-procedure care also lowers complication risks. Overall, earwax removal done correctly is very safe in the majority of patients.
Does insurance cover earwax removal?
Coverage for earwax removal services depends on the specifics of your health insurance plan. Many plans cover removal done by a physician or audiologist as a preventive service. Typical coverage includes:
- Medicare – Covers medically necessary wax removal. Requires copayment for office visits.
- Medicaid – Usually covers professional ear cleaning services.
- Private insurance – Many plans cover some portion, with copays or coinsurance.
- No insurance – Can often receive discounted cash rates when paying out of pocket.
Consult your insurer to learn about your plan’s earwax benefits. Some may limit coverage to once per year or if you meet certain medical criteria. Understanding your coverage can minimize out-of-pocket costs for earwax impaction treatment.
Home treatments: Are they effective?
Some home earwax removal remedies can help loosen and dislodge wax, especially if the impaction is mild. Common options include:
Irrigation
- Using room temperature water
- Aim a steady, gentle stream at the ear-canal opening – do not put tip inside
- Can soften and flush out wax after several applications
- Risk of trapped water and irritation – limit use to once weekly
Cerumenolytic drops
- Contain carbamide peroxide or other wax-softening chemicals
- Requires several days of twice-daily use
- Allows wax to naturally loosen and shed
- May not completely clear blockage; often needs repeat treatments
Mineral oil
- A few drops instilled in the ear can help moisturize and loosen dry wax
- No direct solvent action – takes time to work
- Can soften wax for easier irrigation removal
- Repeat application often needed; little risk with proper use
Other home remedies
- Glycerin – Helps soften dry impacted wax
- Hydrogen peroxide – Oxygen bubbles can dislodge wax
- Sodium bicarbonate – Sodium bicarbonate ear drops help loosen wax
- Olive oil – Lubricates and moisturizes ear canal
- Garlic oil – Some historical use for wax softening
- Apple cider vinegar – Has mild solvent properties
Home treatments are most useful for managing mild wax buildup. More significant blockages usually require professional removal for reliable relief of hearing loss.
Prevention tips
You can reduce excessive earwax buildup by incorporating these preventive measures:
- Avoid unnecessary use of cotton swabs – Pushing wax deeper
- Apply over-the-counter wax softeners periodically
- Have ears cleaned professionally once or twice yearly if prone to impaction
- Avoid earplugs if they tend to worsen wax blockages
- Stay hydrated – Drink plenty of water daily
- Try an antihistamine – Allergies can increase wax production
- Consider prescription-strength drops if OTC options are inadequate
- Get hearing aids adjusted if they seem to push in more wax
- Don’t use objects like bobby pins or keys to clean ears
- Protect ears from insertion of foreign objects like cotton swabs
Conclusion
Earwax blockage is a common cause of temporary conductive hearing loss. Removing excess wax restores hearing to normal in many cases. Professional removal methods are most effective at clearing severe impactions. Home treatments can help manage mild buildup in some individuals.
Preventing excessive earwax is ideal to reduce the risk of impaction and associated hearing loss. Steps like periodic use of softening drops, professional cleaning, and avoiding use of items like cotton swabs can help minimize buildup. Overall, keeping ears and ear canals clean and healthy can let you avoid earwax-related hearing problems.
