What are the symptoms of cerumen (earwax) impaction?

Symptoms of Cerumen Impaction

Cerumen impaction commonly causes hearing loss, tinnitus, fullness, itching, otalgia (ear pain), discharge, odor, and cough. 1 These symptoms occur when earwax accumulates to the point of causing symptoms or preventing proper examination of the ear canal or tympanic membrane.

Common Symptoms

Primary Symptoms

• Hearing loss: Can range from 5 to 40 dB depending on the degree of occlusion 1
• Sensation of ear fullness: One of the most frequent complaints 1
• Tinnitus: Ringing or buzzing sounds in the ear 1
• Ear pain (otalgia): Can range from mild discomfort to significant pain 1

Secondary Symptoms

• Itching: Common irritation symptom in the ear canal 1
• Discharge: Drainage from the ear canal 1
• Odor: Unpleasant smell from the ear 1
• Cough: Reflex cough triggered by stimulation of the auricular branch of the vagus nerve 1
• Dizziness/vertigo: Less common but reported in some cases 1

Symptom Presentation by Population

Cerumen impaction affects different populations with varying prevalence and symptom presentation:

• General population: 2-6% prevalence at any given time 1
• Children: Approximately 10% affected 1
• Healthy adults: About 5% affected 1
• Elderly (>65 years): 19-65% affected, with higher rates in nursing homes 1
• Individuals with cognitive impairment/mental disability: 28-36% affected 1

Functional Impact

Impacted cerumen can significantly impact quality of life through:

• Hearing impairment: Complete occlusion can cause significant hearing loss 1
• Communication difficulties: Especially problematic in elderly populations 1
• Cognitive function: Associated with diminished cognitive function in elderly and developmentally delayed populations 1
• Interference with hearing aids: Can prevent proper fitting and function 2

When to Seek Treatment

Treatment is indicated when cerumen impaction:

1. Causes symptoms as described above 1, 2
2. Prevents clinical examination of the ear canal or tympanic membrane 1, 2
3. Interferes with diagnostic assessment such as audiologic evaluation 1
4. Affects hearing aid users who are prone to cerumen buildup 2

Warning Signs Requiring Prompt Medical Attention

• Severe pain: May indicate complications beyond simple impaction 2
• Ear drainage or discharge: Especially if purulent or bloody 3
• Dizziness that persists: May indicate deeper issues 2
• Sudden hearing loss: Particularly if unilateral 1
• Symptoms that persist after attempted removal: May indicate other pathology 2

Pitfalls in Diagnosis

• Asymptomatic impaction: Up to 17.8% of patients with cerumen impaction may be asymptomatic 4
• Misattribution of symptoms: Hearing loss may be incorrectly attributed to age rather than impaction 1
• Incomplete examination: Failure to properly visualize the tympanic membrane may lead to missed diagnoses 1
• Self-treatment complications: Many patients attempt self-removal with cotton swabs, which can worsen impaction or cause trauma 5, 4

Understanding these symptoms helps in proper identification and management of cerumen impaction, which affects millions of individuals and constitutes a significant proportion of otolaryngological consultations worldwide.