What is the treatment for a blocked ear?

Treatment of Blocked Ear

The treatment depends on the cause: if the blockage is from earwax (cerumen impaction), use cerumenolytic ear drops (such as carbamide peroxide or oil-based drops) for 3-5 days followed by irrigation or manual removal if needed; if symptoms suggest infection (otitis externa) rather than wax, use topical antibiotic drops instead. 1

Step 1: Determine the Cause of Blockage

The first critical step is identifying whether the blocked ear is due to:

• Cerumen (earwax) impaction - characterized by decreased hearing, fullness, tinnitus, or changes to hearing aid function 1
• Otitis externa (ear canal infection) - presents with ear pain, drainage, itching, or tenderness 1
• Other causes - fluid behind the eardrum (otitis media), sudden hearing loss, or eustachian tube dysfunction 1

Seek immediate medical evaluation if you have ear pain, drainage, or bleeding, as these are NOT typical symptoms of simple wax impaction and require different treatment. 1

Step 2: Treatment for Cerumen Impaction (Earwax Blockage)

Home Treatment with Cerumenolytic Drops

For adults and children over 12 years, apply 5-10 drops of carbamide peroxide (Debrox) or hydrogen peroxide twice daily for up to 4 days. 2, 3

Proper administration technique is critical (only 40% of patients do this correctly): 4

• Tilt head sideways with affected ear upward 2, 3
• Fill the ear canal completely with drops 4
• Keep head tilted for 3-5 minutes to allow penetration 4, 5
• Perform gentle to-and-fro movement of the outer ear to eliminate trapped air 4, 5
• Do NOT insert the applicator tip into the ear canal 2, 3

Alternative options include oil-based drops (olive oil, almond oil) or water-based solutions (sodium bicarbonate), though evidence shows no clear superiority of one type over another. 6

When Home Treatment Fails

If drops alone don't clear the wax after 4 days, seek medical attention for professional removal. 1 The clinician can perform:

• Irrigation with warm water using a bulb syringe (only after softening with drops) 6
• Manual removal with appropriate instruments under direct visualization 1, 5
• Aural toilet (professional cleaning) if the canal is obstructed 1, 5

Critical Warnings for Cerumen Treatment

Do NOT use these methods if you have: 1

• Had previous ear surgery
• A perforated eardrum
• Tympanostomy tubes in place (unless cleared by your ENT surgeon)

Never use ear candles - they provide no benefit and can cause serious harm including burns, canal obstruction, and eardrum perforation. 1

Avoid cotton swabs - they push wax deeper and can cause impaction, canal trauma, or eardrum perforation. 1

Step 3: Treatment for Otitis Externa (Infected Ear Canal)

If the blockage is accompanied by pain, drainage, or signs of infection:

Use topical antibiotic ear drops (ofloxacin or ciprofloxacin-dexamethasone) twice daily for 7-10 days as first-line treatment. 1, 4

Administration technique for antibiotic drops: 1, 4

• Have another person administer drops if possible 4
• Lie with affected ear upward 1
• Fill ear canal completely 1
• Stay in position for 3-5 minutes 1, 4
• Press the tragus (cartilage flap in front of ear) in and out to help drops penetrate 1

Keep the ear dry during treatment - avoid swimming and use cotton with Vaseline to protect during bathing. 1, 4

Do NOT use oral antibiotics for uncomplicated otitis externa - they are ineffective, promote resistance, and cause unnecessary side effects. 4

When to Seek Medical Attention

Return to a clinician if: 4

• No improvement after 48-72 hours of proper treatment
• Worsening symptoms
• High fever or spreading redness
• Drops don't easily enter the ear canal (suggests obstruction needing professional cleaning)
• Drainage continues more than 7 days 1

Step 4: Special Populations

Children under 12 years: Consult a doctor before using over-the-counter cerumenolytic drops. 2, 3

Patients with tympanostomy tubes: If the tube is blocked, hydrogen peroxide can be used to clear it (85% success rate), but this should be done under medical supervision. 7

High-risk patients (diabetic, immunocompromised): Require closer monitoring and may need earlier medical intervention. 5

Common Pitfalls to Avoid

• Undermedicating as symptoms improve - complete the full treatment course 4
• Missing the ear canal when administering drops - proper positioning is essential 4
• Allowing water exposure during treatment - this promotes bacterial growth 4
• Discontinuing treatment early - use drops for the full prescribed duration even if symptoms resolve 4
• Overcleaning ears - excessive cleaning irritates the canal and increases impaction risk 1

What NOT to Do

Never insert foreign objects into the ear canal - this includes cotton swabs, bobby pins, keys, or any object smaller than your elbow, as they cause trauma and worsen impaction. 1

Most people do not need routine ear cleaning - earwax is protective and naturally expelled; only treat if symptomatic or obstructing. 1