From the Guidelines
Cerumen impaction can be painful, though not always, and patients may experience a range of symptoms including ear pain, itching, sensation of fullness, tinnitus, and hearing loss. The most recent and highest quality study, 1, reports that patients seek treatment for cerumen impaction for a host of symptoms, including pain, itching, sensation of fullness, tinnitus, odor, drainage, and cough. The study also notes that complete occlusion can result in significant hearing loss, ranging from 5 to 40 dB depending on the degree of occlusion of the canal with cerumen.
Symptoms of Cerumen Impaction
- Ear pain
- Itching
- Sensation of fullness or pressure in the ear
- Tinnitus
- Hearing loss
- Odor
- Drainage
- Cough
The pain typically develops gradually as the impaction worsens and puts pressure on the ear canal. In some cases, attempting to remove the wax with cotton swabs or other objects can push it deeper, causing inflammation of the ear canal and increasing pain. If water becomes trapped behind the impaction, this can lead to infection and more severe pain. However, many people with cerumen impaction experience only mild discomfort or no pain at all, with hearing loss being the primary symptom.
Treatment Options
Treatment typically involves softening the wax with over-the-counter ear drops containing carbamide peroxide, hydrogen peroxide, or mineral oil for a few days, followed by gentle irrigation with warm water using a bulb syringe. For severe or painful impactions, professional removal by a healthcare provider is recommended to avoid damaging the ear canal or eardrum, as noted in 1 and supported by earlier studies such as 1 and 1.
It's worth noting that while cerumen impaction may be asymptomatic in some cases, management may be necessary for diagnostic purposes so that the ear canal and/or tympanic membrane can be visualized or diagnostic assessment can be performed, as stated in 1. The primary outcome considered in this guideline is resolution or improvement in the signs and symptoms associated with cerumen impaction, with secondary outcomes including complications or adverse events.
From the Research
Cerumen Impaction and Pain
- Cerumen impaction can cause various symptoms, including ear fullness, itching, otalgia (ear pain), discharge, hearing loss, and tinnitus 2.
- The management of cerumen impaction includes direct removal, irrigation, and the use of cerumenolytics, which can help alleviate symptoms such as pain 3.
- A study found that 7.3% of patients with cerumen impaction experienced otalgia (ear pain) as a complication of ear syringing 4.
- Another study reported that symptoms attributed to wax, such as deafness and pain, are among the commonest reasons for patients to present to primary care with ear trouble 5.
Symptoms and Complications
- Cerumen impaction can lead to hearing impairment, which may increase the burden of disability on society 4.
- The use of cotton tip applicators in the external auditory canal can push cerumen further into the ear canal, potentially causing impaction and symptoms such as pain 2.
- Aural foreign bodies can also cause ear fullness, otalgia, discharge, and hearing loss, and are more common in children than adults 2.
Treatment and Management
- Cerumenolytics and irrigation of the ear canal are reasonable first-line therapies for cerumen impaction and can help alleviate symptoms such as pain 6.
- Manual removal of cerumen is also an option, but requires specialized training and equipment to prevent adverse outcomes, including pain 6.
- Ear drops, such as oil-based or water-based cerumenolytics, can be used to aid in the removal of ear wax and alleviate symptoms such as pain 5.