Can cerumen (earwax) buildup cause dizziness?

Can Cerumen Impaction Cause Dizziness?

Yes, cerumen impaction can cause dizziness, though it is less commonly relieved by earwax removal compared to other symptoms like hearing loss and ear fullness. According to clinical practice guidelines from the American Academy of Otolaryngology-Head and Neck Surgery, only 40% to 50% of patients who complained of dizziness reported improvement after ear lavage for cerumen impaction 1.

Mechanism and Symptoms of Cerumen Impaction

Cerumen (earwax) impaction can cause various symptoms through different mechanisms:

1. Direct pressure effects:

   • Pressure on the tympanic membrane
   • Blockage of the ear canal causing altered pressure dynamics

2. Common symptoms associated with cerumen impaction:

   • Hearing loss (5-40 dB depending on degree of occlusion) 2
   • Sensation of ear fullness
   • Tinnitus
   • Itching
   • Pain or discomfort
   • Ear discharge
   • Cough
   • Dizziness/vertigo 1, 2

Diagnostic Considerations

When evaluating dizziness potentially related to cerumen impaction:

• Perform otoscopic examination to confirm presence and extent of cerumen impaction
• Consider alternative diagnoses if dizziness persists after cerumen removal
• Assess for complete occlusion - hearing acuity typically doesn't diminish until the cross-sectional area of the ear canal is reduced by at least 80% 1
• Evaluate for other ear pathologies that may cause dizziness and can be masked by cerumen

Treatment Approach for Cerumen Impaction

If cerumen impaction is suspected as the cause of dizziness:

1. Cerumenolytic Agents

• Water-based: sodium bicarbonate, sterile saline, hydrogen peroxide
• Oil-based: mineral oil, almond oil
• Non-water/non-oil based: carbamide peroxide (recommended by guidelines) 2

2. Irrigation Methods

• Success rate: 68-92% 2
• Can be performed after cerumenolytic pretreatment
• Home irrigation with bulb syringe may be appropriate for selected adults 3

3. Manual Removal

• Success rate: approximately 90% 2
• Performed with curette, probe, hook, forceps, or suction under direct visualization

Special Considerations and Cautions

• Patients with coagulopathies or on anticoagulant therapy require special care during removal to avoid bleeding 1, 3
• Immunocompromised patients may be at higher risk for post-procedure infections 1
• Avoid cotton-tipped swabs and ear candling, which can worsen impaction 4, 3
• Potential complications include tympanic membrane perforation, ear canal laceration, infection, bleeding, worsening hearing loss, otitis externa, pain, dizziness, and syncope 2

When to Refer to an Otolaryngologist

Referral is indicated if:

• Treatment with cerumenolytic agent followed by irrigation is ineffective
• Manual removal is not possible
• Patient develops severe pain or vertigo during irrigation
• Hearing loss or dizziness persists after cerumen has been removed 4

Conclusion

While cerumen impaction can cause dizziness, it's important to note that only about 40-50% of patients with dizziness experience improvement after cerumen removal 1. If dizziness persists after successful cerumen removal, further evaluation for alternative diagnoses is warranted.