Q: What’s the best product to use for earwax removal? I’ve always heard of people using mineral oil, but now I’m seeing videos online of people using kits that flush the ear. Are these safe to use?
Earwax may not seem particularly useful, but it plays an important role in keeping our ears healthy. Also called cerumen, earwax is produced by glands in outer ear canal and mixes with natural oils and dead skin cells to form the wax we see in our ears.
Earwax protects and lubricates the ear canal. Its sticky consistency traps dust, dirt and other particles while helping protect the skin from moisture and infection. In most people, earwax does not need to be removed. The ear has a natural self-cleaning process that gradually moves wax toward the opening of the ear canal, where it dries and falls out or can simply be wiped away.
Problems arise when too much wax builds up and blocks the ear canal, a condition known as cerumen impaction. Since the spring, pharmacists at select New Brunswick pharmacies have been offering ear infection assessments as a fee-based service that is not currently covered by Medicare. This has given me the opportunity to see varying degrees of wax buildup, including ear canals that are completely blocked. Impaction is more common in people who naturally produce a lot of wax, have narrow or particularly hairy ear canals, use hearing aids, AirPods or earplugs, or regularly clean their ears with cotton swabs (Q-tips).
Regular use of cotton swabs can actually make wax buildup worse by pushing it farther into the ear canal. Cotton swabs can also scratch the delicate skin inside the ear or, if inserted too far, damage the eardrum.
Impacted earwax can cause a plugged or full sensation, decreased or muffled hearing, discomfort, itching or ringing in the ear. Significant pain, warmth, swelling, drainage or bleeding should be assessed by a healthcare professional rather than assumed to be caused by wax.
When treatment is needed, the three main approaches are wax-softening drops, irrigation and manual removal. No single method has been proven to be best for everyone.
Mineral oil remains a reasonable and inexpensive place to start. A few drops can soften and lubricate hardened wax, helping it work its way out naturally. Another self-care option widely available in pharmacies is Murine Ear Drops, which contain carbamide peroxide to soften and loosen wax. Bubbling, fizzing or crackling may occur while the drops are working. Murine is also available as a kit that combines the drops with a bulb syringe for gently irrigating the ear afterward.
Irrigating the ear can be effective, particularly after the wax has been softened, but it is not necessarily better than drops alone. The water should be close to body temperature as water that is too hot or cold can cause dizziness or nausea.
Ear irrigation is not appropriate for everyone. Do not irrigate if you have or may have a perforated eardrum, have tubes in your ears, have had certain ear surgeries, or have significant ear pain, warmth, swelling, drainage or an active ear infection. People with diabetes, a weakened immune system or abnormalities of the ear canal should speak with a healthcare provider before attempting irrigation.
High-pressure devices that forcefully spray water into the ear should also be avoided, as they can injure the ear canal or eardrum. Ear candling is not recommended because it has not been shown to effectively remove earwax and can cause burns or other injuries.
For an otherwise healthy person with mild wax buildup, mineral oil or an over-the-counter earwax-softening product for a few days is a reasonable first step. Carbamide peroxide products such as Murine should be used for no more than four days. If the blockage does not clear, gentle irrigation may be an option if you have none of the risk factors mentioned above.
If your ear remains blocked, your hearing is noticeably reduced or you are unsure whether earwax is causing the problem, have the ear examined. Manual removal should never be attempted at home. If I find an ear canal completely blocked while assessing for an infection, I may recommend softening or gentle irrigation when appropriate. If the blockage cannot be cleared or irrigation is not safe, I will refer the patient for further care.
Remember, some earwax is normal and beneficial. If it is not causing symptoms or blocking the ear canal, the best approach is usually to leave it alone.