How to Remove Ear Wax: Which Is The Best Method?

Dr Soren Thompson demonstrating how to remove ear wax using microsuction

Table of Contents

Welcome to the definitive guide on how to remove ear wax, where we explore several methods of earwax removal to help you decide the best method. Earwax, or cerumen, is a natural substance that protects the ears from dust, debris, and bacterial growth. In most cases, earwax naturally works its way out of the ear canal, but sometimes, it can build up and cause discomfort or hearing problems. When this happens, removal becomes necessary. However, with various removal methods available, it can be challenging to determine which is the best choice for your ears.

From the traditional approach of ear irrigation, which includes techniques like syringing, to the precision of microsuction, this article compares all the top methods to help you clear your ears for better hearing. We’ll also evaluate the utility of manual earwax removal tools and discuss the effectiveness of over-the-counter ear drops.

We have already written an article on ear candles, so we’ll exclude them from this comparison. TLDR: Ear candles are not recommended due to their ineffectiveness

Our goal is to provide clear, straightforward advice on removing earwax to limit complications and effectively and efficiently keep your ears functioning at their best. From practical tips to safety precautions, this article will equip you with the knowledge to tackle earwax buildup confidently.

Ear Irrigation vs. Microsuction vs. Manual Tools vs. Ear Drops: Why Are There So Many Options?

Earwax removal is a relatively common procedure, reflecting a routine health concern for most people.

Cerumen, or earwax, accumulation is estimated to affect up to 6% of people worldwide. The prevalence is more pronounced in certain age groups; about 10% of children, 5% of adults, and 33% of older adults experience excessive or impacted cerumen that may necessitate intervention.

In the United States, an estimated 12 million visits to medical offices annually are for cerumen impaction.

In the UK, particularly in England and Wales, ear irrigation, once the standard method of earwax removal, is conducted around 2.3 million times yearly.

These statistics collectively illustrate that earwax removal is a common aspect of healthcare, with a substantial number of the population requiring professional intervention at various stages of life to address earwax buildup.

The high prevalence of earwax impaction has created a market with multiple solutions. However, not all solutions are equal; some may prioritise profit over efficacy.

Factors Affecting Ear Wax Build Up

The aging process affects the earwax glands, decreasing their number and function. Consequently, earwax becomes drier and less mobile, making it more challenging to expel naturally from the ear canal. Coarsening of ear canal hairs in older adults further impedes the movement of earwax.

Several other factors play a role in the likelihood of earwax buildup, including:

Anatomical Considerations:

  • A naturally narrow or constricted external ear canal.
  • Bony growths within the ear canal, such as osteomas or exostoses.
  • A hairy external ear canal that can trap wax.

Physical Obstructions:

  • The use of hearing aids which can block the passage of earwax.
  • Earplugs similarly create a barrier to wax expulsion.
  • The chronic use of cotton buds, which often push wax deeper into the ear rather than removing it

Characteristics of the Earwax:

  • Individuals who produce a harder consistency of earwax.
  • Drier earwax is usually due to the atrophy of cerumen glands with advancing age.
  • Inflammation of the ear canal, or otitis externa, can alter wax production and removal

Other Factors:

  • People with learning disabilities may have an increased risk of impaction.
  • Dermatological conditions like eczema, psoriasis, or seborrhoeic dermatitis can affect the skin lining the ear canal and alter wax consistency.

Given the variety of these risk factors and their prevalence, it’s understandable why earwax removal is a standard and often necessary procedure to prevent and treat impaction and its associated complications.

The Challenges of Earwax Removal

Grasping the subtleties of earwax removal begins with understanding the ear canal’s intricate design and the eardrum’s delicacy, two factors that make the process both complex and delicate.

The Complexity of the Ear Canal

Contrary to what one might assume, the ear canal is not a straight shot to the eardrum; it’s an “S-shaped” path that meanders, presenting challenges for any removal process. This complex shape requires careful navigation to ensure no harm to the surrounding delicate tissues during earwax removal.

The Fragility of the Eardrum

As a gateway to the middle ear, the eardrum is a vital but vulnerable part of our auditory system. This thin membrane can vibrate in response to even the slightest sounds, and having such sensitivity means it is pretty delicate. 

Skin Dynamics Within the Ear Canal

The inner skin of the ear vastly differs from the skin on the rest of our body. The external auditory canal’s skin is rich in glands and is notably thinner, especially over the bone, making it more susceptible to injury.

Regular bodily mechanisms like skin shedding don’t operate the same way within the ear canal due to the absence of friction.

Instead, the ear employs a unique migration process where old skin cells travel outward, mingling with earwax and eventually exiting the ear—the potential for an injury to disrupt the conveyance underscores the need for careful intervention.

Why Caution Is Key

Inserting objects into the ear canal to clear wax can impede this natural migration and risk damage to this sensitive structure. The proverbial caution against putting anything smaller than your elbow into your ear is rooted in this genuine possibility of harm.

Understanding these complexities underlines the importance of selecting a safe and effective earwax removal method that respects the ear’s anatomy and self-cleaning processes.

As we delve into the available methods, remembering these anatomical nuances will help us appreciate the necessary care with such procedures.

Ear Irrigation

Earwax removal via irrigation, encompassing everything from classic syringing to modern water jet systems, essentially uses water pressure to dislodge and remove earwax. While this method may appear straightforward, it’s essential to recognise that it comes with challenges and risks, regardless of the specific technique or product used.

Consider a blocked sink – when you try to clear it with water pressure, the blockage might shift, but it could also be pushed further down the pipes or resist movement, causing water to back up. Similarly, when water pressure is used in the ear, there’s a risk it won’t effectively remove impacted earwax, and it can be quite an uncomfortable experience.

As we age, our ear anatomy changes, including the thinning and stiffening of the eardrum, making it more susceptible to injury. 

Furthermore, syringing, one of the most common forms of ear irrigation, isn’t suitable for everyone. It’s not recommended for individuals with certain ear conditions, such as a perforated eardrum, previous ear surgeries, or those with only one functioning ear. There’s also the risk of aggravating conditions like otitis externa (an infection of the outer ear canal) or tinnitus (ringing in the ears).

A healthcare practitioner demonstrates how to remove ear wax using an ear irrigation method.
A method of ear irrigation using a water jet and cup to catch the water as it exits the ear.

A survey of Australian general practitioners revealed that 38% had encountered complications following ear syringing, with issues ranging from unsuccessful wax removal to more severe outcomes like eardrum perforation and ear canal damage. It’s estimated that 1 in 1000 ears treated with irrigation may experience significant complications.

One medical defence organisation has found that as many as 20% of such claims against general practitioners are related to complications from ear syringing. The breakdown of these claims sheds light on the primary concerns associated with the procedure:

Poor Technique

This is the leading cause, accounting for 43% of claims. It highlights the need for proper training and skill when performing ear syringing to minimise the risk of injury to the patient.

Faulty Equipment

Making up 26% of claims, this points to ensuring all equipment is in good working order before proceeding with ear syringing to avoid equipment-related complications.

Excessive Pressure

Also responsible for 26% of claims, using too much pressure during syringing can lead to damage within the ear, emphasising the need for careful control of the irrigation process.

Failure to Examine the Ear Before Syringing 

Although it accounts for a smaller percentage (5% of claims), examining the ear before syringing is crucial to identify any conditions that might contraindicate the procedure, such as a perforated eardrum or an ongoing infection.

These statistics underscore the importance of thorough training, equipment maintenance, procedure moderation, and pre-procedural examinations to mitigate the risks associated with ear syringing.

Given these concerns, it’s vital for those who are immunocompromised, such as older people, diabetics, or those with weakened immune systems, to approach ear irrigation with caution. Earwax typically helps maintain an acidic environment that deters bacterial and fungal growth, so its removal can disrupt this natural defence mechanism.

While ear irrigation can be adequate for some, it carries inherent risks and inefficiencies. Those considering this method for earwax removal should be fully informed of the potential complications and discuss alternative options with a healthcare provider.

Microsuction

Ear Health’s long-standing presence in New Zealand since 1995 as a provider of microsuction services showcases a strong track record in ear care. The anecdotal absence of significant incidents is notable, with hundreds of thousands of microsuction procedures conducted. While no medical procedure is without risk, microsuction stands out for having a risk profile that is considerably more favourable when compared to other earwax removal methods.

Despite the success of microsuction, some healthcare and audiology providers continue to use ear irrigation, a method with a higher incidence of complications. The preference for irrigation over microsuction may be influenced by the logistical and financial barriers associated with setting up a microsuction service. The equipment required for microsuction is sophisticated and represents a substantial investment compared to the basic tools used for irrigation. 

Audiologist Dr Soren Thompson operating the ZEISS OPMI Pico For Otorhinolaryngology microscope during the earwax removal procedure.
Audiologist Dr Soren Thompson operating the ZEISS OPMI Pico microscope during an earwax removal procedure.

Moreover, microsuction is not a procedure that just anyone can perform; it demands a skilled hand. Nurses and audiologists trained in microsuction deeply understand ear anatomy, the nuances of potential ear diseases, strict infection control practices, and the techniques to ensure patient comfort during the procedure. In contrast, other earwax removal methods can be attempted by persons without the same expertise and training, which can lead to a greater risk of complications.

The tools of microsuction are specialised and precise:

Vision

Using specialised microscopes or surgical loupes, paired with ear speculums, allows for a clear and magnified view of the ear canal and eardrum during the procedure.

Extraction

Medical-grade vacuum pumps and suction tubes delicately remove earwax without requiring invasive pressure.

Position and Access

An adjustable medical bed ensures the patient is in the correct position for safe and efficient wax removal.

The research underscores the effectiveness of microsuction, with one study citing a 91% success rate in earwax removal across a sample of 159 individuals. In addition to its high success rate, microsuction boasts several advantages over other methods:

  • When performed by a trained practitioner, it is a quicker process.
  • The practitioner has an unobstructed view of the ear canal before and during the procedure.
  • It doesn’t introduce moisture to the ear canal, reducing the risk of infection.

Crucially, microsuction is suitable for individuals who are typically advised against irrigation, such as those with eardrum perforations, previous ear surgeries, foreign objects in the ear, or even mild otitis externa (external ear canal infection). This versatility further solidifies microsuctions’ position as a leading method of earwax removal, offering a better alternative to other techniques.

Manual Tools

Many people need earwax removal and are looking for solutions for how to remove earwax, including how to remove stubborn earwax at home. From the humble cotton bud (cotton swab or Q-tip) to the illustrious motorised spiral earwax removal tool, there are many options for manual tools.

DALL-E generative AI image of a man using a motorised spiral earwax removal tool.
Generative AI impression of a man using a motorised spiral earwax removal tool.

However, this task is so delicate that even professionals may find it challenging to address it with manual tools alone.

When ear irrigation is unsuccessful or is not an option (for example, due to a perforated eardrum or weakened immune system), a general practitioner (GP) typically will not attempt a manual removal. Instead, they will refer the patient to a specialist. ENTs, or otolaryngologists, are trained to handle complex cases, including those where the earwax has formed a stubborn blockage.

Inserting objects or tools too far into the ear for cleaning purposes can be dangerous, as it risks puncturing the eardrum, particularly in an area known as the pars tensa.

Located at the bottom front of the eardrum, the pars tensa is the eardrum’s central panel and is extremely thin. Its delicate structure, being only a few cell layers thick, is highly susceptible to damage. Therefore, using cotton swabs or bobby pins for ear cleaning often proves ineffective and potentially harmful.

Using manual tools to remove stubborn earwax at home can exacerbate the problem by pushing earwax deeper into the ear canal, heightening the likelihood of impaction and injury to the sensitive structures within the ear.

Medical professionals caution against using at-home earwax removal kits, which can aggravate the problem. Regular ear cleanings might be necessary for some individuals under medical supervision. Still, this isn’t the case for many, and the ear should be left to its natural self-cleaning mechanisms.

The external auditory canal, lined with a thin layer of skin containing ceruminous and sebaceous glands, is susceptible to trauma, and even mild scratches can lead to infection. Therefore, self-cleaning attempts can increase the risk of injury and symptoms related to ear damage. Public health education should focus on discouraging self-cleaning practices. Instead, it should inform how the ear naturally cleans itself and when to seek help for issues like itchiness or earwax buildup.

An important takeaway is that earwax accumulation is not necessarily related to personal hygiene; it is often a natural, constitutional occurrence. Misguided attempts to remove earwax with cotton swabs, needles, and hairpins can damage the skin, promote impaction, and disrupt the ear’s natural cleaning process. This emphasises the need for professional earwax management and educating the public on more appropriate ear health practices.

Ear Drops

Over-the-counter and homemade ear drops, including cerumenolytic agents, sodium bicarbonate, olive oil, almond oil, and saline solutions, are widely used to manage earwax buildup. These products soften the earwax, making it easier to expel from the ear canal naturally or with the help of additional procedures.

However, it’s important to note that these cerumenolytic agents may not always be fully effective in clearing impacted earwax. While they can help loosen mild earwax buildup, there are instances where further intervention may be needed, particularly with deeply impacted wax. For example, products like Cerumol have been noted to facilitate the loosening and removal of ear wax. However, Cerumol acknowledges that “professional ear syringing” might still be necessary for complete removal in some cases.

Furthermore, research suggests more straightforward solutions like water and saline can be as effective as more expensive over-the-counter eardrops. This finding is significant as it offers a more accessible and cost-effective option for individuals with earwax problems.

Ear drops are a standard first-line treatment to alleviate these symptoms by softening the wax. They are often used with other removal methods, especially if the wax is not fully cleared with drops.

And it’s essential to recognise that despite the availability and initial ease of use of over-the-counter options, microsuction emerges as the superior method of earwax removal, particularly for challenging cases.

Using ear drops before a microsuction should only be done if the clinic suggests or if there is an established history of past earwax removals showing that drops are required before the appointment.

While ear drops can be a helpful tool in managing mild earwax buildup, they should be selected and used with an understanding of their limitations. 

Key Takeaways

In summary, each method of earwax removal—ear irrigation, microsuction, manual removal, and ear drops—has unique features and considerations.

Ear irrigation is a common but invasive method that uses water pressure to remove wax, which can be crudely effective but also carries risks like eardrum perforation and infection.

Microsuction, a less invasive technique performed by trained professionals, stands out for its precision and efficacy, especially for those with certain ear conditions. However, microsuction requires more expensive equipment and extensive training.

Manual removal, typically reserved for specialised cases, requires training and should be conducted by healthcare experts.

Lastly, over-the-counter ear drops can soften earwax for mild occurrences, though they may not be sufficient for more severe cases of impaction.

Ultimately, the choice of method depends on individual circumstances and the severity of wax buildup. Consulting with a healthcare professional is always recommended to determine the most effective approach for your needs.

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Brett Thomas
Brett Thomas
Guest
7 months ago

I was Recomended By Lakes Primecare in Rotorua to Ear Health & I was very Impressed with Excellent Proffesional Expert Polite Friendly Help shown to me & I Thoroughly Recomend Ear Health to Everyone needing Attention to Their Ears. The Rotorua Nurse Louise will certainly Help solve your Ear Problems. Louise Kind Friendly Polite & Certainly is Well Trained in her Job.
Thank You Ear Health Rotorua for Excellent Service.

Brett Thomas
Brett Thomas
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Reply to  Eric Andre
7 months ago

You are Most Welcome Eric.
I Certainly will be going back again future.
I had never heard or knew there was a Excellent Place like this before. I am very Impressed. Thank you.

Dennis G
Dennis G
Guest
7 months ago

Several years ago, I visited Ear Health in Birkenhead/Northcote as my hearing was degenerating due to wax buildup.
The first time was a revelation! My hearing was deteriorating steadily, and I was ignoring it, putting it down to ageing.
The hearing loss had just become part of life, but the wax buildup was exacerbating the underlying damage.
Ron Trounson helped me obtain hearing aids when I explained how I came to damage my ears in my early working years. Factory work in noisy environments was the primary cause.
I applied to ACC and was assisted with the costs involved in acquiring hearing aids. The combination of hearing aids and ear wax removal was amazing.
I’m glad to say that I am still getting older… and I accept the fact that wax builds up over time. It’s part of life.
And so… I returned recently.
Again this time, instant and significant improvement at a very reasonable cost.
I recommend Ear health to anyone suffering hearing loss. Wax removal especially. It seems miraculous.
I intend to book a visit every year from now on.

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