Management of Ear Wax

Age from 6 months onwards.

When should earwax be removed?

  • If earwax is totally occluding the ear canal and any of the following are present:
    • Hearing loss
    • Earache
    • Tinnitus
    • Vertigo
    • Cough suspected to be due to earwax
  • If the tympanic membrane is obscured by wax but needs to be viewed to establish a diagnosis.
  • If the person wears a hearing aid, wax is present and an impression needs to be taken of the ear canal for a mould, or if wax is causing the hearing aid to whistle.

How should earwax be removed?

  • Explain that removal of earwax may not necessarily relieve the symptoms (for example hearing loss may be a sensorineural loss and not due to impacted wax).
  • Prescribe ear drops for 3–5 days initially, to soften wax and aid removal.
    • Sodium bicarbonate 5%, sodium chloride 0.9%, olive oil, or almond oil drops can be used (do not prescribe almond oil ear drops to anyone who is allergic to almonds).
      • Sodium chloride 0.9% is not available as a proprietary ear drop product. However, sodium chloride 0.9% nasal drops can be prescribed for use in the ear (off-label use).
    • Do not prescribe drops if you suspect the person has a perforated tympanic membrane.
    • Warn the person that instilling ear drops may cause transient hearing loss, discomfort, dizziness and irritation of the skin.
  • If symptoms persist, consider ear irrigation (see Scenario: Ear irrigation), providing that there are no contraindications.
  • If irrigation is unsuccessful, there are three options:
    • Advise the person to use ear drops for a further 3–5 days and then return for further irrigation.
    • Instill water into the ear. After 15 minutes irrigate the ear again.
    • Refer to an Ear Nose and Throat specialist for removal of wax.
  • Advise anyone who has had earwax removed to return if they develop otalgia, or significant itching of the ear, discharge from the ear (otorrhoea), or swelling of the external auditory meatus, as this may indicate infection.