Guidelines for Ear Wax Removal

Today's I am writing about a very practical problem: ear wax removal. This plagues my family and many of my patients too. Fortunately, this problem has been examined by independent and well respected organizations. First, let's review some background facts. Cerumen (ear wax) occurs naturally and is actually a defense mechanism to prevent infections in the outer ear canal. The composition of cerumen varies between people and races. Cerumen should not automatically be removed unless it is causing a problem. Two examples would be interfering with drainage of water from the outer ear canal and causing reduced hearing. According a Cochrane Review,"Using ear drops to remove impacted ear wax is better than no treatment, but no particular sort of drops can be recommended over any other." Further,"water and saline drops appear to be as good as more costly commercial products." The ear, nose, throat organization, American Academy of Otolaryngology, reviewed this problem and produced a guideline, which agreed with the Cochrane Review. Use of water irrigation was most effective when done 15-30 minutes after instilling a wax removing agent into the outer ear canal. If these two steps are ineffective, then seeking medical care should be the next step, because this may involve manually removing the cerumen. There is a risk of infection or ear drum perforation, then hearing loss. They did not recommend using a Q-tip, an oral irrigator with a special tip, or ear candling. Another good summary by the American Hearing Research Foundation for this problem with good pictures can be found at here. Although this predates the AAO Guidelines, they generally agree. One more point, I like their prevention method of regularly instilling some sterile olive oil or baby oil into outer ear canals. This will soften up ear wax. I have heard this tip from several ENT doctors and I recommend it to my patients routinely.

If you have questions about removing ear wax, ask your doctor.