Irrigation (also called ear syringing), which involves flushing out ear wax with a low-pressure jet of warm (body temperature) water, works up to 70 to 90 percent of the time.
The Best Way to Remove Ear Wax
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
One of the most common reversible causes of hearing loss is earwax buildup. Earwax is normal, and if it isn’t causing symptoms, should be left alone. It doesn’t start interfering with hearing acuity until it clogs off at least 80 percent of the ear canal. Ironically, hearing aids are a risk factor for excessive ear wax, as are anything else you put in your ear, like ear plugs, since that stimulates the earwax glands. For further irony, so may cotton-tipped swabs that as many as two-thirds of people use to clean their ears. You may think you’re making things better by swabbing out your ears, but you may actually be making them worse. Simply removing protective wax can leave your ear canals dry, itchy, and achy or even lead to “Q-tip otalgia,” a term coined to refer to an ear pain syndrome caused by cotton-tipped swabs. You shouldn’t need to clean your ear canals at all, because the wax should make its way out on its own.
That’s right. Ears are self-cleaning. The lining of your ear canal grows outward from your ear drum, so secreted earwax and any dirt that’s trapped is eventually conveyor belted out of the ear. However, this self-cleaning mechanism can fail in 1 in 20 younger adults, and in as many as 1 in 3 older adults, and lead to excessive or impacted earwax accumulation, though they may not even know it. Seventy percent of those surveyed who had both ears completely blocked with wax thought their hearing was good. But when their ears were cleared, they were suddenly able to hear better. Clearing out impacted wax can also improve symptoms of ear irritation, pressure, and fullness. So, what’s the best way to do it?
Q-tips are a no-no. Pushing anything into the ear canal can end up making things worse by impacting wax even deeper into the ear or traumatizing the canal, resulting in abrasions, infections, or even, rarely, eardrum perforation. There’s even a case report of a cotton swab causing a brain abscess and fatal meningitis, though the presence of wood splinters suggests the tip had broken off inside the ear. Cotton swab packaging already cautions users against ear canal insertion, but perhaps warning labels should be made even clearer, wrote one clinical medical officer: “do not go near the ear hole or avoid the ear altogether.”
What about those ear drops sold for wax removal? There are about a dozen different marketed formulations on the market, none of which appears to work any better than any other, or even compared to saline (which is just salt water) or plain tap water. But five days of treatment does clear ear wax in about one in five cases compared to only one in 20 that clear up on their own within that time. In the very least, those ear drops may be able to soften wax before bulb syringe irrigation.
Irrigation (also called ear syringing) involves flushing out the wax with a low-pressure jet of warm (body temperature) water. It works up to 70 to 90 percent of the time, and if it doesn’t, clinicians have fancy devices to manually remove the wax under direct observation. The irrigation can be tried at home, though. People randomized to use a bulb at home had about a 50 percent success rate in clearing their obstruction, and armed with this knowledge, were significantly less likely to subsequently require in-office irrigation. Significant complications only happen in approximately one in 1,000 irrigations.
You should not use an oral water jet. There are papers with names like “Catastrophic Otologic Injury from Oral Jet Irrigation of the External Auditory Canal.” Even at one-third power, Waterpiks were shown to be able to perforate the ear drums of fresh cadavers. Those who insist on violating this advice should at the very least use the lowest setting, use a tip with multiple orifices, and make sure the water stream is directed only against the walls of the ear canal and never straight back towards the ear drum. But really, just don’t do it.
Please consider volunteering to help out on the site.
- Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical Practice Guideline (Update): Earwax (Cerumen Impaction). Otolaryngol Head Neck Surg. 2017;156(1_suppl):S1-S29.
- Nagala S, Singh P, Tostevin P. Extent of cotton-bud use in ears. Br J Gen Pract. 2011;61(592):662-663.
- Baxter P. Association between use of cotton tipped swabs and cerumen plugs. Br Med J (Clin Res Ed). 1983;287(6401):1260.
- Barton RT. Q-tip otalgia. JAMA. 1972;220(12):1619.
- Lewis-Cullinan C, Janken JK. Effect of cerumen removal on the hearing ability of geriatric patients. J Adv Nurs. 1990;15(5):594-600.
- Oron Y, Zwecker-Lazar I, Levy D, Kreitler S, Roth Y. Cerumen removal: comparison of cerumenolytic agents and effect on cognition among the elderly. Arch Gerontol Geriatr. 2011;52(2):228-232.
- Nussinovitch M, Rimon A, Volovitz B, Raveh E, Prais D, Amir J. Cotton-tip applicators as a leading cause of otitis externa. Int J Pediatr Otorhinolaryngol. 2004;68(4):433-435.
- Goldman SA, Ankerstjerne JK, Welker KB, Chen DA. Fatal meningitis and brain abscess resulting from foreign body-induced otomastoiditis. Otolaryngol Head Neck Surg. 1998;118(1):6-8.
- Aaron K, Cooper TE, Warner L, Burton MJ. Ear drops for the removal of ear wax. Cochrane Database Syst Rev. 2018;7(7):CD012171.
- Keane EM, Wilson H, McGrane D, Coakley D, Walsh JB. Use of solvents to disperse ear wax. Br J Clin Pract. 1995;49(2):71-72.
- Coppin R, Wicke D, Little P. Managing earwax in primary care: efficacy of self-treatment using a bulb syringe. Br J Gen Pract. 2008;58(546):44-49.
- Coppin R, Wicke D, Little P. Randomized trial of bulb syringes for earwax: impact on health service utilization. Ann Fam Med. 2011;9(2):110-114.
- Nieman CL, Oh ES. Hearing loss. Ann Intern Med. 2020;173(11):ITC81-ITC96.
- Dinsdale RC, Roland PS, Manning SC, Meyerhoff WL. Catastrophic otologic injury from oral jet irrigation of the external auditory canal. Laryngoscope. 1991;101(1 Pt 1):75-78.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
One of the most common reversible causes of hearing loss is earwax buildup. Earwax is normal, and if it isn’t causing symptoms, should be left alone. It doesn’t start interfering with hearing acuity until it clogs off at least 80 percent of the ear canal. Ironically, hearing aids are a risk factor for excessive ear wax, as are anything else you put in your ear, like ear plugs, since that stimulates the earwax glands. For further irony, so may cotton-tipped swabs that as many as two-thirds of people use to clean their ears. You may think you’re making things better by swabbing out your ears, but you may actually be making them worse. Simply removing protective wax can leave your ear canals dry, itchy, and achy or even lead to “Q-tip otalgia,” a term coined to refer to an ear pain syndrome caused by cotton-tipped swabs. You shouldn’t need to clean your ear canals at all, because the wax should make its way out on its own.
That’s right. Ears are self-cleaning. The lining of your ear canal grows outward from your ear drum, so secreted earwax and any dirt that’s trapped is eventually conveyor belted out of the ear. However, this self-cleaning mechanism can fail in 1 in 20 younger adults, and in as many as 1 in 3 older adults, and lead to excessive or impacted earwax accumulation, though they may not even know it. Seventy percent of those surveyed who had both ears completely blocked with wax thought their hearing was good. But when their ears were cleared, they were suddenly able to hear better. Clearing out impacted wax can also improve symptoms of ear irritation, pressure, and fullness. So, what’s the best way to do it?
Q-tips are a no-no. Pushing anything into the ear canal can end up making things worse by impacting wax even deeper into the ear or traumatizing the canal, resulting in abrasions, infections, or even, rarely, eardrum perforation. There’s even a case report of a cotton swab causing a brain abscess and fatal meningitis, though the presence of wood splinters suggests the tip had broken off inside the ear. Cotton swab packaging already cautions users against ear canal insertion, but perhaps warning labels should be made even clearer, wrote one clinical medical officer: “do not go near the ear hole or avoid the ear altogether.”
What about those ear drops sold for wax removal? There are about a dozen different marketed formulations on the market, none of which appears to work any better than any other, or even compared to saline (which is just salt water) or plain tap water. But five days of treatment does clear ear wax in about one in five cases compared to only one in 20 that clear up on their own within that time. In the very least, those ear drops may be able to soften wax before bulb syringe irrigation.
Irrigation (also called ear syringing) involves flushing out the wax with a low-pressure jet of warm (body temperature) water. It works up to 70 to 90 percent of the time, and if it doesn’t, clinicians have fancy devices to manually remove the wax under direct observation. The irrigation can be tried at home, though. People randomized to use a bulb at home had about a 50 percent success rate in clearing their obstruction, and armed with this knowledge, were significantly less likely to subsequently require in-office irrigation. Significant complications only happen in approximately one in 1,000 irrigations.
You should not use an oral water jet. There are papers with names like “Catastrophic Otologic Injury from Oral Jet Irrigation of the External Auditory Canal.” Even at one-third power, Waterpiks were shown to be able to perforate the ear drums of fresh cadavers. Those who insist on violating this advice should at the very least use the lowest setting, use a tip with multiple orifices, and make sure the water stream is directed only against the walls of the ear canal and never straight back towards the ear drum. But really, just don’t do it.
Please consider volunteering to help out on the site.
- Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical Practice Guideline (Update): Earwax (Cerumen Impaction). Otolaryngol Head Neck Surg. 2017;156(1_suppl):S1-S29.
- Nagala S, Singh P, Tostevin P. Extent of cotton-bud use in ears. Br J Gen Pract. 2011;61(592):662-663.
- Baxter P. Association between use of cotton tipped swabs and cerumen plugs. Br Med J (Clin Res Ed). 1983;287(6401):1260.
- Barton RT. Q-tip otalgia. JAMA. 1972;220(12):1619.
- Lewis-Cullinan C, Janken JK. Effect of cerumen removal on the hearing ability of geriatric patients. J Adv Nurs. 1990;15(5):594-600.
- Oron Y, Zwecker-Lazar I, Levy D, Kreitler S, Roth Y. Cerumen removal: comparison of cerumenolytic agents and effect on cognition among the elderly. Arch Gerontol Geriatr. 2011;52(2):228-232.
- Nussinovitch M, Rimon A, Volovitz B, Raveh E, Prais D, Amir J. Cotton-tip applicators as a leading cause of otitis externa. Int J Pediatr Otorhinolaryngol. 2004;68(4):433-435.
- Goldman SA, Ankerstjerne JK, Welker KB, Chen DA. Fatal meningitis and brain abscess resulting from foreign body-induced otomastoiditis. Otolaryngol Head Neck Surg. 1998;118(1):6-8.
- Aaron K, Cooper TE, Warner L, Burton MJ. Ear drops for the removal of ear wax. Cochrane Database Syst Rev. 2018;7(7):CD012171.
- Keane EM, Wilson H, McGrane D, Coakley D, Walsh JB. Use of solvents to disperse ear wax. Br J Clin Pract. 1995;49(2):71-72.
- Coppin R, Wicke D, Little P. Managing earwax in primary care: efficacy of self-treatment using a bulb syringe. Br J Gen Pract. 2008;58(546):44-49.
- Coppin R, Wicke D, Little P. Randomized trial of bulb syringes for earwax: impact on health service utilization. Ann Fam Med. 2011;9(2):110-114.
- Nieman CL, Oh ES. Hearing loss. Ann Intern Med. 2020;173(11):ITC81-ITC96.
- Dinsdale RC, Roland PS, Manning SC, Meyerhoff WL. Catastrophic otologic injury from oral jet irrigation of the external auditory canal. Laryngoscope. 1991;101(1 Pt 1):75-78.
Motion graphics by Avo Media
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The Best Way to Remove Ear Wax
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
If you missed the previous video, see Are There Any Benefits to Ear Candling?.
I covered hearing loss in a one-hour webinar and Q&A. Check out the recording.
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