Earwax: Should It Be Removed?

W. Steven Pray, PhD, DPh; Joshua J. Pray, PharmD


US Pharmacist. 2005;30(5) 

In This Article

Cerumen Impaction


Cerumen impaction can be a result of ineffective attempts to remove earwax.[4] This results from a common misconception about cotton-tipped applicators. When the patient inserts one of these into the ear and withdraws it, the brownish discoloration typical of cerumen can be seen. The assumption is that the total mass of cerumen has adhered to the applicator. Unfortunately, this is false. While a bit of cerumen does discolor the applicator, the bulk of the more solid mass of cerumen is rammed further into the ear by the applicator. Ceruminokinesis is unable to move this harder wax, and the impaction begins. Continued cerumen production occurs between the impaction and the tympanic membrane, adding to the impacted mass. Physicians may discover impactions so well organized that they appear to resemble a cast of the inside of the ear when removed.


Impacted cerumen can cause itching of the ear, pain, tinnitus, dizziness, cough, vertigo, and increased risk of infection.[2,5] It may also compromise hearing. The otic canal should be completely clear to allow sound vibrations to impact upon the tympanic membrane. Any obstruction hampers hearing to some degree. A partial cerumen impaction can impair hearing. However, a total cerumen occlusion produces a conductive hearing loss that can be as profound as that experienced by those who purposely insert wax hearing protectors to preserve their hearing in the presence of loud sounds.[4]


Patients more prone to cerumen impaction include those who zealously try to remove earwax, those with a tortuous ear canal, those who overproduce cerumen, the elderly, patients with mental retardation, and those with spinal cord injury.[2,4,6]