Treatment for Clogged Ear
For cerumen impaction (earwax buildup), the most effective treatment is using a cerumenolytic agent followed by irrigation if needed, with manual removal by a healthcare professional reserved for cases where these methods fail. 1
Diagnosis and Assessment
- Symptoms of cerumen impaction include decreased hearing, fullness, tinnitus, and distortion/changes to hearing aid function 1
- Clinicians should diagnose cerumen impaction when an accumulation of cerumen causes symptoms, prevents needed assessment of the ear, or both 1
- Other conditions like otitis media, otitis externa, and sudden inner ear hearing loss can masquerade as cerumen impaction, so proper assessment is essential 1
Treatment Options
Home Treatment
Water-based agents (most effective for disintegration of cerumen):
Oil-based agents (soften cerumen without disintegrating it):
Non-water, non-oil-based agents:
- Carbamide peroxide (urea-hydrogen peroxide) 1
Application Method for Ear Drops
- Lie down with the affected ear up 1
- Put enough drops in the ear canal to fill it up 1
- Stay in this position for 3-5 minutes (use a timer) 1
- Use a gentle to-and-fro movement of the ear or press with an in/out movement on the tragus (small piece of cartilage in front of the ear) to help the drops penetrate 1
- Wipe off any excess drops after getting up 1
Professional Treatment
- Irrigation: Performed after cerumenolytic application if needed 1
- Manual removal: Using curette, probe, hook, forceps, or suction under direct visualization 1
- For refractory cases: Referral to a specialist with specialized equipment (microscope or otoendoscope) 1
Effectiveness of Treatments
- No specific cerumenolytic agent has been proven superior to another 1, 2
- All cerumenolytic agents tend to be more effective than no treatment 1, 2
- Success rates for resolving cerumen impactions with irrigation range from 68% to 92% 1
- Success rates for manual removal with a binocular microscope are around 90% 1
- A randomized controlled trial found that commercial products (Cerumenex and Murine) were no more effective than saline placebo for removing earwax 3
Precautions and Contraindications
- Do not use ear drops if there is ear pain, drainage, or bleeding 1
- Avoid irrigation or cerumen-removing/softening drops if the patient has had ear surgery or a perforated eardrum 1
- Cerumenolytics should be avoided in patients with active infections of the ear canal 1
- Potential adverse effects include discomfort, transient hearing loss, dizziness, and skin irritation 1
- Do not use ear candles as there is no evidence they remove impacted cerumen and they can cause serious damage 1
Prevention of Cerumen Impaction
- Avoid overcleaning ears as excessive cleaning may irritate the ear canal and increase chances of cerumen impaction 1
- Never insert anything smaller than your elbow into the ear (e.g., cotton swabs, hair pins, toothpicks) 1
- For hearing aid users, regular ear canal checks every 3-6 months are recommended 1
- Clean hearing aids as recommended by the manufacturer 1
When to Seek Medical Attention
- If home remedies are unsuccessful in resolving symptoms 1
- If there is ear pain, drainage, or bleeding 1
- For patients with hearing loss, ear fullness, and ear pain if not certain they are from cerumen 1
- When repeated attempts to clear cerumen are unsuccessful or complications occur 1
Special Considerations
- For elderly adults, developmentally delayed patients, or young children who cannot express symptoms, cerumen removal may be necessary even without clear symptoms 1
- For hearing aid users, cerumen impaction can affect hearing aid function and should be addressed promptly 1
- In rare instances, sedation or general anesthesia may be needed for patients unable to tolerate removal procedures 1