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Earwax

 


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Class
Ear, nose and throat
Description
Excess wax in the ears is a common cause of easily treatable hearing impairment. Ear wax is a natural, wax-like substance that is produced by special glands in the skin lining the ear canals. Ear wax keeps the ear canal clear by repelling water, and trapping dust particles and small foreign bodies such as insects. The wax then works its way to the outside where it is wiped away or flakes off.
Causes
Ear wax only causes problems when it builds up. This can happen when too much wax is produced or it is not able to work its way out naturally. Wax builds up more easily in people who have very narrow ear canals in one or both ears, or obstructions like hair in the ear canal. In these cases, excess wax can build up behind the narrowing or obstruction and can block off the ear canal altogether. The wax then dries and becomes hard and immobile. In babies' ears, the wax is very soft and the ear canal is short, so it is common to see a 'runny ear' caused by wax. This is completely normal and does not need to be treated, just cleaned as usual.
Symptoms
An excess of ear wax can make it increasingly difficult to hear, and can produce a feeling that something is blocking the ear. If the ear canal is completely blocked, the pressure inside may cause a pain in the ear - a bit like the pain experienced when taking off or when landing in an aeroplane or when diving under water. When the ear is completely blocked, an infection can set in behind it. This can be very painful, and can lead to a discharge from the ear, increasing deafness, and sometimes causing a noise or ringing in the ear called tinnitus.
Treatment
Wax can be removed by adding a few drops of medicinal grade olive oil to the ear canal twice a day for a few days to soften the wax. Olive oil found in the kitchen cupboard should not be used as this is food-grade oil and not sufficiently pure to be used in the ears. Alternatively, there are a large number of ear drops available from the local pharmacy that will soften or break up the wax to allow it to leak out naturally.
When to see your pharmacist
Ask your pharmacist for advice if you or your child is experiencing problems with ear wax. It is important that you describe your symptoms clearly and tell the pharmacist how long the symptoms have been present. If your pharmacist decides that a build up of wax in the ears is responsible for the symptoms, there are a number of preparations of ear drops that can be supplied without the need for a prescription. Ear drops containing arachis oil (Cerumol) or docusate sodium (Molcer, Waxsol) will help soften the wax, while ear drops containing urea-hydrogen peroxide (Exterol, Otex) will help break up the wax. If ear ache is also a problem, ear drops containing choline salicylate may be recommended to ease the pain. If the pain is severe, your pharmacist may also suggest the use of analgesics such as ibuprofen or paracetamol.
When to see your doctor
If symptoms of hearing loss persist beyond a week, despite treatment with wax softeners, or if there is persistent pain in the ear, unrelieved by simple painkillers, see your doctor to get the ear checked. Your doctor will look in the ear to confirm that the problem is ear wax and may then arrange for the ear to be syringed with warm water to remove the wax. If there is infection present, this may require treatment with antibiotics, which are applied directly into the ear as ear drops, or taken by mouth as tablets, capsules or liquids.
Living with ear wax
Do not be apprehensive if you have been told that your ears will need to be syringed to remove a build-up of ear wax. The procedure is normally performed by the practice nurse, it is painless and takes just a few minutes to do. Two to three days before your appointment, it will help if ear drops are used to soften or break up the wax as this makes the wax easier to remove by syringing. Depending upon your circumstances, the nurse may decide to treat just one ear, to allow your hearing to recover before calling you back for another appointment to treat the other ear.

If the build-up of wax is a frequent problem, the periodic application of ear drops will prevent the wax from hardening, ease its natural dispersal and reduce the need for future syringing.

Avoid the desire to poke things in the ear in an attempt to dislodge the wax as it is likely only to make things worse.
Advice for carers
If you care for someone with ear problems who needs help putting drops in the ear, learn to apply the preparations properly. Your pharmacist is always available to provide help if you need it.

When putting drops in someone else's ear, it is easier if the person lies on one side with the affected ear uppermost. With one hand, gently move the ear so that you can see into the ear canal more easily. With the other hand, bring the ear dropper close to the ear, resting the hand on the side of the face for balance and to avoid touching the ear with the dropper. Squeeze the ear dropper gently, allowing a drop to fall one at a time into the ear. Count out the required number of drops. Release the ear and ask the person to remain on their side for a few moments. If necessary, a small plug of cotton wool placed in the ear will help to keep the drops in the ear canal while the wax softens. If necessary, repeat the procedure for the other ear, if both ears are affected.
Useful Tips
  • Do not put anything in the ear - hairgrips, paperclips, and even cotton wool buds can damage the delicate lining of the ear canal
  • Do not use ear drops if you think there is a perforation of the ear drum
  • Wear ear protectors if you work in a noisy environment
  • Ear plugs will help to keep out dust, if this is causing problems with the ears


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