What is earwax?

Earwax is a natural secretion which forms a protective coating on the skin in the ear canal. Wax is produced in the ear canal and helps protect our ears from infection. It is gently pushed out of our ears by the action of migrating skin in our ears. The skin grows from the eardrum, along the ear canal, and eventually falls out of our ears mixed with wax. Ears are therefore self-cleaning and we should not be tempted to try and remove wax with cotton buds, as this can push the wax deep into the ear, damage the skin of the ear canal, and cause infections.

Some people have narrow ear canals, or wax that becomes dry, which prevents skin and wax falling out of their ears.  The quantity of earwax produced varies greatly from person to person. 

A doctor or nurse can look into the ear canal and confirm a plug of earwax has formed. A plug of earwax is not a serious problem, more a nuisance.  You only need to remove earwax if wax build-up is causing symptoms such as dulled hearing or problems with a hearing aid. 

How to remove earwax using ear drops 

Earwax usually falls out on its own. If it doesn’t and blocks your ear, to help with this natural process, and enable the ear to clean itself, we advise the use of medical grade certified Olive Oil drops to soften the wax. Olive Oil bought from a Chemist does not contain any chemicals which may cause irritation. Following this process up to two or three times a day, for two to three weeks should help. This softens the wax so that it comes out of its own accord without harming the ear. You will not necessarily see wax come out. It often seems to come out unnoticed.  You can continue for any length of time, but three weeks is usually enough.  If olive oil does not work you can buy sodium bicarbonate drops from pharmacies.

Step-by-step guide to administering ear drops 

• Warm the drops to room temperature before using them 
• Lie on your side with the affected ear facing up when putting in drops 
• Gently pull and push your outer ear to work the drops in,  apply 1-2 drops
• Gently massage the area in front of the ear
• Stay lying down for 10 minutes to allow the drops to soak into the earwax. 
• It is not advisable to put cotton wool in your ear/ears as this will soak up the eardrop

If olive oil does not work you can buy sodium bicarbonate drops from pharmacies. As an alternative to Olive Oil, Sodium Bicarbonate is a medicated ear wax softener. It also helps to dissolve ear wax. It is not recommended for long term use as it can irritate the skin in the ear canal.

To administer sodium bicarbonate, follow the step-by-step guide to administering ear drops.

Bulb syringing 

In most cases ear drops will clear a plug of earwax. However if this is unsuccessful a bulb syringe may be an alternative way to clear your ears from wax.

An ear bulb syringe is a small bulb shaped rubber object which can be filled with water and then used to squirt the water gently into the ear to remove earwax.  The main benefit of the bulb syringe is that you can use it yourself without needing to make an appointment with your practice nurse or GP.  There are some risks using a bulb syringe including ear infection, failure to remove the wax and eardrum perforation but these risks are low. 

Bulb syringes can be purchased from a pharmacy and can be reused. Please be aware that you should not share the syringe with other people for hygiene reasons.

When should a bulb syringe not be used? 

Do not use a bulb syringe in the following circumstances: 

• Pain in the ear 
• A history of eardrum perforation in the affected ear 
• A recent history of an ear infection in the affected ear 
• Symptoms of infection in the ear – usually pain or smelly discharge 
• If you only have one hearing ear which is the affected ear 
• Previous ear surgery on the affected ear.

In the above circumstances please make an appointment to see your practice nurse or GP to have your ears examined and appropriately treated.

Step-by-step guide to using a bulb syringe 

It is essential to use olive oil drops twice a day for at least 14 days prior to bulb syringing to soften the wax. Alternatively you can purchase ear drops from your pharmacy (please read the manufacturer’s leaflet.) 

• Wash your hands 
• Use a bowl of clean warm (not hot) water, that is warm to the touch, but not too hot or too cold on your skin 
• Prepare the syringe by squirting it in the water a few times to fill it up with warm water 
• Gently pull your outer ear up and out to help straighten out the canal and allow better access for the water 
• Tilt your head so the ear to be treated is facing upwards 
• Place the tip of the syringe into the opening of the ear – Do NOT push the syringe further into the ear – and GENTLY squirt one or more bulb syringes of water into your ear. (You can do this in the shower or the bath or lie on the bed with a towel underneath your head to catch the water) 
• Allow the water to remain in your ear for at least 60 seconds 
• Gently tilt your head in the opposite direction and wiggle the outer ear to help the water and wax come out. (This can be done over the sink) 

If you experience any pain during or before this procedure stop immediately and see a practice nurse or GP for a review. 

When self-care methods don’t work 

If you have tried the methods above and after three weeks or more you still have persisting wax please make an appointment with your GP surgery to discuss.

In straightforward cases a practice nurse might be able to provide ear irrigation or ear syringing but ear syringing can lead to ear infections, perforated ear drum and tinnitus (persistent noise) and therefore it is only performed in exceptional circumstances. 

Other sources of information 

NHS Health A to Z: https://www.nhs.uk/conditions/earwax–build–up/  

NHS 111  

NHS Choices:  www.nhs.uk/pages/homepage.aspx  

NICE (National Institute for Health and Clinical Excellence):  www.nice.org.uk