Earwax Blockage: How It Forms and What You Can Do About It

A blocked ear caused by an earwax plug is unpleasant: sounds are muffled, your ear feels full and sometimes there is a beep or ringing as well. In most cases you can soften the plug yourself at home with lukewarm water. This article explains how earwax blockage forms, how to recognise it, how to get rid of it step by step and when you should call your GP straight away.

What is earwax and what does it do?

Earwax (cerumen) is not dirt but protection. It traps dust and bacteria and keeps the skin of your ear canal supple. Your ear cleans itself: chewing and talking slowly move old earwax outwards. Whatever appears on the outside, you wipe away with a flannel. You can read more about this in how to clean your ears and remove earwax yourself.

How does an earwax plug form?

An earwax plug forms when the natural removal of earwax stalls. The wax builds up, hardens and eventually blocks the ear canal partly or completely. The risk is higher with:

• cotton buds, which push earwax deeper into your ear;
• earbuds, custom hearing protection or a hearing aid, which hold back the natural flow;
• a narrow or curved ear canal;
• getting older, because earwax becomes drier and harder;
• naturally producing a lot of earwax.

Wearing earplugs every day is not a problem in itself, as long as you keep them clean. You can read how in how to clean earplugs.

Symptoms of earwax blockage: how to tell you have a plug in your ear

The symptoms usually come on gradually and vary from person to person:

• muffled hearing, as if there is cotton wool in your ear
• a full or pressured feeling in your ear
• itching or mild pain in the ear canal
• a beep, hissing or ringing in your ears
• sometimes mild dizziness

Has your ear suddenly blocked completely, often after a shower or a swim? Then the earwax has probably absorbed water and swollen. A blocked ear can also have other causes, such as a cold or a pressure difference. We list them in blocked ear: causes and what to do.

When to call your GP: the warning signs

Make a regular appointment with your GP if your ear is still blocked after 5 days of self-care, if you have pain or itching, or if you have grommets or a hole in your eardrum.

Removing an earwax plug: step by step

No warning signs? Then you can usually soften an earwax plug yourself at home. The steps below follow the advice of Thuisarts, the Dutch patient website of the Dutch College of General Practitioners. International guidance points the same way: the American ENT guideline on earwax (AAO-HNS, 2017) names water or saline as a softener and found no single treatment method that works better than the others. Your own doctor can advise you on the rules and options in your country.

1. 1Soften the plug with lukewarm water or olive oil. Once a day for 5 days, let lukewarm water run slowly into your ear from the shower head for 3 seconds, with the blocked ear facing up. Or put 5 drops of lukewarm water into your ear twice a day for 5 days and stay in that position for 2 minutes. Or use olive oil: put a few drops into your ear canal 2 to 3 times a day. According to Dutch ENT doctor Dr Jan Rombout, this usually softens the earwax faster.
2. 2Skip the pharmacy drops. According to the Dutch GP guidance, ear drops from the pharmacy are not needed: there is not enough research showing that they work better than water.
3. 3Ear often blocked? Use a bulb syringe. Fill an ear bulb syringe with lukewarm water, place the tip carefully at the entrance of your ear and squeeze the bulb gently. Do not do this if you have ear pain, grommets or a hole in your eardrum.
4. 4Leave the rest to your ear. Only wipe away what you can see on the outside, with a flannel or tissue. No cotton buds, hairpins or other objects in your ear canal.
5. 5Still blocked after 5 days? Then see your GP or have the plug removed. Above all, stop poking around: anything you put in your ear pushes the plug deeper.

Would you rather not do it yourself, or do plugs keep coming back? Then you can have your earwax removed at Audinc, at our locations in the Netherlands: no referral needed, by microsuction under direct vision.

A lump of earwax falls out of your ear: is that normal?

Yes, that is usually exactly what you want. Once lukewarm water has softened the earwax, it moves outwards. Sometimes it comes out in small pieces, sometimes a large plug comes out in one go, for example after a shower or when you wake up. Such a plug is usually yellow, brown or almost black and may look bigger than you expected.

If you can hear clearly again afterwards and have no pain, there is nothing you need to do. You may be sensitive to loud sounds for a moment, because suddenly you can hear everything again.

Do have it checked if your ear stays muffled (part of the plug is often still there), if blood, pus or fluid comes out with it, or if you develop pain. If your hearing suddenly gets much worse or you have a fever, call your GP or the out-of-hours doctor service straight away.

How is an earwax plug removed professionally?

There are two common methods. With ear irrigation (syringing), the ear canal is flushed with lukewarm water, usually at the GP’s surgery. The person treating you looks into your ear before and after, but not during the flushing itself. Irrigation is not suitable if you have grommets or a hole in your eardrum.

With microsuction, the earwax is removed dry with a small medical suction device, while the ear canal stays in view the whole time. A curette is used where needed. No water pressure is involved.

At Audinc, we remove earwax by microsuction under the supervision of ENT doctor Dr Jan Rombout. We offer this at our Dutch locations: you pay €25 online in advance for the examination and €27.50 per ear at the location. Have a normal earwax plug without warning signs and want it removed? Read how earwax removal at Audinc works. Planning to have custom earplugs fitted? We can’t take an impression while there is a plug; what that means for your appointment, you can read in should I have my ears cleaned out before a fitting?

Above: an ear canal blocked with earwax, and the same ear canal after microsuction.

How to prevent an earwax plug

• Do not use cotton buds, not even “just at the entrance”.
• Keep earbuds, custom earplugs and hearing aids clean.
• Do you often get plugs, or do you wear earplugs or a hearing aid every day? Then have your ears checked now and then. If you have no symptoms, there is no need: your ear cleans itself.

Wondering whether earplugs harm your ears? Read are earplugs bad for your ears?