What is ear wax for and why do we have it?

Ear wax (the medical term is cerumen) has several important functions. It traps dust, dirt, and small particles before they reach the eardrum. It is mildly antibacterial and antifungal, helping to keep infections out. It moisturises the skin of the ear canal so it doesn't become dry and itchy. And it is acidic, which discourages bacterial growth. People without enough wax often have dry, itchy, easily irritated ear canals that get infected. Wax is a feature, not a bug.

Are cotton buds bad for your ears?

Yes. Cotton buds (Q-tips) feel like they are cleaning the ear, but what they actually do is push most of the wax deeper into the canal while picking up only a small amount on the way out. Over time, this causes a hard plug of wax to build up against the eardrum, which is exactly what people are trying to avoid. Cotton buds can also scratch the delicate skin of the ear canal and introduce infection, and can cause more serious injury if pushed in far, including perforated eardrums and disrupted hearing bones. The simple rule is: don't put anything smaller than your elbow into your ear. The outer part of the ear can be wiped with a damp facecloth, but the inside of the ear canal is not your job.

What are the best ear drops to soften ear wax?

The right drops depend on the situation. For mild build-up or general maintenance, sterile olive oil drops or sprays (such as Earol) are gentle and well-tolerated. Important caveat: there is good evidence that using olive oil every day over a long period can actually make wax build-up worse, so it should be used occasionally, no more than about once a week if used preventively, rather than daily. For impacted wax that needs clearing, water-based drops are more effective at breaking up the plug. Sodium bicarbonate ear drops have the strongest evidence in this category and outperform most alternatives in comparative trials. Urea/hydrogen peroxide preparations such as Otex Express are a reasonable alternative. Do not use any drops if you have a known hole in the eardrum, an active ear infection, or a grommet.

How can I prevent ear wax build-up?

There isn't a magic bullet for preventing ear wax. Most conventional advice (daily olive oil, weekly drops, ear washouts) doesn't have evidence behind it, and in some cases can make things worse. The realistic measures that do help are: stop using cotton buds, which is the single most effective change most people can make; don't use softening drops daily as a preventive measure, but only when you notice wax starting to build up; if you wear hearing aids, keep them clean and change wax guards regularly; treat any underlying skin conditions such as eczema or psoriasis properly; and if you are genuinely prone to recurrent wax, plan a check-up every 6 to 12 months rather than waiting for symptoms. For most people the patients who do best are the ones who leave their ears alone and come in when they actually need to.

Can wax removal hide other problems with my ear?

It can. A blocked or full feeling in the ear is not always wax, even when it really feels as though it must be. The same sensation can be caused by Eustachian tube dysfunction, middle ear fluid, hearing loss for other reasons, or sometimes more involved problems sitting deeper in the ear. It is also not unusual to find something more behind the wax, such as an ongoing ear infection, an underlying hole in the eardrum, or in some cases an early cholesteatoma. High-street wax removal services do a good job of taking wax out but are not set up to give a proper ENT examination of the ear behind it. If the wax has been hiding the problem, you may walk out with a clean ear canal and the original symptoms still there. This is why a thorough examination of the entire eardrum, including the upper part where some conditions can hide, is part of every wax appointment with an ENT surgeon.

Ear Wax

Q: Do ear candles work and are they safe?

No. Ear candles do not work and they are dangerous. Multiple studies have shown that ear candles produce no measurable suction inside the ear canal. The wax you see in the candle afterwards is just burnt candle wax and soot, not anything from the ear, which is easy to demonstrate by burning the same candle without putting it anywhere near an ear. Documented injuries from ear candles include burns to the face and ear canal, dripping wax that blocks the ear canal further, perforation of the eardrum, and even house fires. Ear candles are widely considered unsafe by the medical and regulatory communities and should not be used.

Q: Should I use olive oil from my kitchen for ear wax?

No. If you are using olive oil for ear wax, use sterile, pharmaceutical-grade olive oil drops or sprays sold over the counter at pharmacies, not the bottle of olive oil from your kitchen cupboard. Cooking olive oil is not sterile and can introduce bacteria or other contaminants into the ear. The pharmacy preparations are inexpensive and properly suitable for use in the ear.

Q: Why does my hearing feel worse after starting ear drops?

Many patients find their hearing feels worse for the first day or two after starting softening drops. This is normal and happens because some of the drop fluid gets trapped in front of or behind the wax plug, briefly making the blockage more complete. It usually settles within a couple of days as the wax starts to soften and break up. It is not a reason to stop using the drops.

Q: What is microsuction and is it safe?

Microsuction is the use of a fine suction tube to gently remove ear wax under direct vision through a high-magnification operating microscope. Because the surgeon can see exactly what they are doing throughout, it is precise, controlled, and very safe. There is no water involved, which makes it suitable for patients with a hole in the eardrum, a grommet, a previous ear operation, or any history of ear infections. The procedure is quick, usually 5 to 15 minutes, and is generally painless. Microsuction is considered safer and more controlled than ear syringing or irrigation, which involve flushing water into the canal and have largely fallen out of favour in the NHS for that reason.

Q: Is it normal for ear wax to be different colours?

Yes. Ear wax varies a lot in colour and texture from one person to the next, and even from one ear to the other. It can be anything from pale yellow and soft, through honey-coloured and slightly tacky, to dark brown, almost black, and quite hard. Some people make wet, sticky wax; others make dry, flaky wax. All of these are normal. Colour and texture are partly genetic and partly down to age, as wax tends to dry out as we get older. What is normal for one person is not necessarily normal for another, so the colour of the wax on a cotton bud is not a reliable way to tell whether anything is wrong. If you have new symptoms, the colour or consistency of the wax matters far less than the fact that something has changed.

Ear wax (the medical term is cerumen) is one of those things people often see as a nuisance, but it actually has an important job. Healthy ears make wax for very good reasons. Most of the time the body deals with it without anyone needing to do anything, and most of the trouble people get into with their ears comes from trying to clean wax out themselves. This page covers what wax is for, what to do (and what not to do) when there's a build-up, and what your options are if you do need it removed properly.

I see patients with wax problems regularly in my practice. Most are easily sorted with a quick clean under the microscope, but a few need more than that, and a very small number have wax problems linked to a narrow ear canal that can be helped with surgery. There is more on each below.

What is ear wax for?

Ear wax has several important functions:

It traps dust, dirt, and small particles before they reach the eardrum
It is mildly antibacterial and antifungal, helping to keep infections out
It moisturises the skin of the ear canal so it doesn't become dry and itchy
It is acidic, which discourages bacterial growth

People without enough wax often have dry, itchy, easily irritated ear canals that get infected.

Wax also varies a lot in colour and texture from one person to the next, and even from one ear to the other. It can be anything from pale yellow and soft, through honey-coloured and slightly tacky, to dark brown, almost black, and quite hard. Some people make wet, sticky wax; others make dry, flaky wax. All of these are normal. Colour and texture are partly genetic and partly down to age (wax tends to dry out as we get older). If you have new symptoms, the colour or consistency of the wax matters far less than the fact that something has changed.

How does the ear clean itself?

The skin of the ear canal is the only skin in the body that grows outwards. It starts on the eardrum and slowly migrates along the canal towards the outside. As it goes, it carries wax, dead skin cells, and any debris with it. By the time the wax reaches the outer part of the ear, it has dried out, and it usually falls away on its own, often during sleep. This is called the migratory system, and in most people it does the whole job perfectly well without any help. You really do not need to clean inside your ears.

Problems start when the migratory system is interrupted. The most common reason is putting things into the ear canal, with cotton buds being by far the worst offender. Other factors include having a narrow or unusually-shaped ear canal where the wax can't make its way out easily, or having a type of wax that is naturally drier and harder (this is more common with age).

Two specific situations are worth flagging because they come up often in clinic and patients are usually surprised by them.

The first is wearing hearing aids or regular in-ear earphones. Both physically block the outer part of the canal and prevent wax from migrating out the way it should. Many hearing aid users find they need microsuction more often than they otherwise would, sometimes every few months, simply because the aids themselves are interfering with the ear's normal self-cleaning. This isn't a sign that anything is wrong with the ear; it just goes with the territory of wearing an aid, and it is easily managed with regular check-ups.

The second is skin conditions of the ear canal, particularly eczema and psoriasis. The skin in the ear canal can be affected by these conditions just like the skin anywhere else, and when it is inflamed it produces more debris than usual and the migratory system doesn't work as efficiently. The result is more frequent wax problems, often with itching as well. The key point here is that cleaning out the wax is only half the job. The underlying skin condition also needs treating, usually with prescribed steroid drops or cream applied to the canal, otherwise the same problem will keep coming back. If you have eczema or psoriasis elsewhere on your skin and also struggle with recurrent wax or itchy ears, do mention this when you come in.

Cotton buds make wax problems worse, not better

This is the single most important practical message on this page. Cotton buds (Q-tips) feel like they are cleaning the ear, but what they are actually doing is pushing most of the wax deeper into the canal while picking up only a small amount on the way out. Over time, this causes a hard plug of wax to build up against the eardrum, which is exactly what people are trying to avoid.

There are two other problems with cotton buds:

They can scratch the delicate skin of the ear canal and introduce infection. The ear canal is one of the few places where minor scratches don't drain and air out easily, so they can become infected surprisingly quickly.
They can cause more serious injury if pushed in far. I have looked after patients with perforated eardrums and disrupted hearing bones from cotton bud injuries, often after they were startled or knocked while a bud was in the ear.

The simple rule: don't put anything smaller than your elbow into your ear. If you want to clean the outer part of the ear (the bit you can see), a damp facecloth wrapped over your finger works fine. The inside of the ear canal is not your job.

Things that can help at home

If you are prone to wax build-up, the goal is not to get the wax out yourself but to keep the wax soft so the ear's own migratory system can move it out naturally.

Softening drops

Softening drops are the simplest, safest, and most useful home measure for ear wax. The evidence here is genuinely useful: a Cochrane review confirmed that drops of any sort are better than doing nothing, and a number of laboratory and clinical studies have gone on to compare different drops head-to-head. The pattern that emerges is clear, and worth using to choose the right product for the right job.

The most useful way to think about it is to separate two situations: keeping wax soft as part of general ear maintenance, and dealing with an ear that is already impacted.

For mild build-up or general maintenance: olive oil

If your ears are prone to wax but you are not currently blocked, the goal is to keep the wax soft and mobile so the ear's own cleaning system can do its job. Olive oil is the most widely recommended option for this. It works mainly by lubricating and softening the wax, rather than actively breaking it up, but for prevention and gentle use that is exactly what you want. It is well-tolerated and very low risk.

A genuinely important point about olive oil that surprises a lot of patients (and some clinicians too): there is good evidence that using it every day over a long period can actually make wax build-up worse rather than better. A clinical study using video otoscopy showed that nightly olive oil use over six months led to significantly more wax in the canal compared to control ears. The more useful approach is to use olive oil occasionally rather than daily: when you can feel wax starting to build up, or as a short course of a few days before a planned wax-removal appointment.

In practical terms: a few drops or sprays of sterile olive oil (such as Earol Olive Oil Spray, available at Boots or Amazon) used as needed, or no more than about once a week if you are using it preventively, is the right kind of frequency.

For impacted wax: water-based drops

If your ear is properly blocked, oil-based drops are not the most effective option. Lab studies have shown that olive oil does relatively little to disintegrate a hard wax plug. Water-based drops, which work by drawing water into the wax and breaking it up, perform much better in head-to-head comparisons. Sodium bicarbonate solution has the strongest evidence in this category and consistently outperforms most alternatives, including saline alone, in comparative trials. Urea/hydrogen peroxide preparations also have good evidence behind them and are a reasonable alternative.

In practical terms: Otex Sodium Bicarbonate Ear Drops, available at Boots or Amazon, used a few times a day for up to a week, will often shift things on its own, or at least make professional removal much quicker and more comfortable. Otex Express, a urea-hydrogen peroxide preparation available at Boots or Amazon, is a reasonable alternative if you cannot get sodium bicarbonate.

The trade-off with these more active drops is that they can be a little more irritating to the skin of the ear canal, and the fizzing of hydrogen peroxide drops can briefly make hearing worse before it gets better. They are not really meant for long-term daily use, but for clearing an actual impaction they do the job.

Before a microsuction appointment

If you have an appointment booked for stubborn impacted wax, I usually advise three to five days of softening drops in the affected ear before the appointment. Sodium bicarbonate is what I most often recommend for this because it tends to shift hard wax faster, but olive oil is a perfectly reasonable alternative if your ear canal is sensitive or you have it to hand.

How to use any drops

Lie on your side with the affected ear facing up, put in a few drops, and stay lying down for 10 to 15 minutes so the drops have time to spread along the canal and soak into the wax. Two or three times a day is usually plenty.

A small but important point: if you are using olive oil, please use the sterile, pharmaceutical-grade olive oil drops or sprays sold over the counter at pharmacies, not the bottle of olive oil from your kitchen cupboard. Cooking olive oil isn't sterile and can introduce bacteria or other contaminants into the ear, which is the last thing you want. The pharmacy preparations are inexpensive and properly suitable for use in the ear.

If you are using drops to soften wax before a microsuction appointment, keep using them right up until the day of the appointment itself. If you stop a few days early, the wax can dry out and re-harden, which makes removal harder and more uncomfortable than if you had not used drops at all. The same logic applies if you are trying to clear wax at home: don't stop the moment you think things are improving, because the wax can firm back up.

A common surprise: many patients find their hearing feels worse for the first day or two after starting softening drops. This is normal, and it happens because some of the drop fluid gets trapped in front of or behind the wax plug, briefly making the blockage more complete. It usually settles within a couple of days as the wax starts to soften and break up. It is not a reason to stop using the drops.

Important: don't use any ear drops if you have a known hole in the eardrum, an active ear infection, or a grommet in place. If you are not sure whether your eardrum is intact, see a doctor first. Drops getting into the middle ear through a hole can cause pain, dizziness, or infection.

Diet, hydration, and the rest of it

You may have read that diet, vitamins, or supplements can affect ear wax. The honest answer is that good general hydration and skin health probably help a little, but there are no specific foods or supplements with reliable evidence for changing wax. The most useful thing you can do is leave your ears alone and use softening drops when needed.

Preventing wax build-up: what actually works

A lot of patients ask what they can do day-to-day to stop wax building up in the first place. The honest answer is that there isn't a magic bullet, and most of the conventional advice (daily olive oil, weekly drops, ear washouts) doesn't have evidence behind it. In some cases, as with the daily olive oil point made earlier, it can actively make things worse. The realistic measures that do help are smaller and more practical than people often expect:

Stop using cotton buds. This is the single most effective change most people can make. The ear was designed to clean itself, and cotton buds are the most common reason that process fails.
Don't fall into the trap of using softening drops daily as a preventive measure. Use them only when you notice wax starting to build up, or as a short course before an appointment if removal is planned. For most people prone to recurrent wax, occasional use, no more than about once a week, is enough.
If you wear hearing aids, look after them properly. Keep them clean, change the wax guards or filters regularly as the manufacturer recommends, and wipe them down before putting them back in. Hearing aid users typically need professional wax removal more often than other patients regardless of what they do at home, but well-maintained aids do reduce the frequency.
If you have eczema or psoriasis in the ear canal, treating the skin condition properly is one of the most effective things you can do to reduce wax problems (more on this in the migratory system section above).
If you are genuinely prone to recurrent troublesome wax, the most reliable strategy is to come in for a planned check-up every 6 to 12 months rather than waiting for symptoms to develop. A quick microsuction clean before things get impacted is much easier, quicker, and more comfortable than dealing with a fully blocked ear that has been there for weeks.

What I will not tell you is that there is a daily routine that will keep your ears wax-free. For most people there isn't one, and the patients I see who do best are the ones who leave their ears alone and come in when they actually need to.

Things that don't work and aren't safe

This section matters because some of these methods are widely advertised and look harmless.

Ear candles (also called ear coning). Ear candles are hollow wax cones that are placed in the ear and lit at the top, supposedly creating a vacuum that pulls wax out. They do not work, and they are dangerous. Multiple studies have shown that ear candles produce no measurable suction inside the ear canal. The "wax" you see in the candle afterwards is just burnt candle wax and soot, not anything from the ear, which is easy to demonstrate by burning the same candle without putting it anywhere near an ear.

The risks are real. Documented injuries from ear candles include burns to the face and ear canal, dripping wax that blocks the ear canal further, perforation of the eardrum, and even house fires. Ear candles are widely considered unsafe by the medical and regulatory communities, and they should not be sold with medical claims. Please don't use them.

Ear vacuums and "wax suction kits" sold online. These are battery-powered devices that claim to suction wax out of the ear at home. The suction they generate is not strong enough to remove impacted wax, but it is sometimes strong enough to damage the delicate skin of the ear canal or the eardrum if the device is pushed too far in. They should not be confused with the medical-grade microsuction equipment used in clinic, which is a completely different setup and used under direct vision through a microscope.

Ear "irrigation kits" or syringing equipment for home use. Although ear irrigation has historically been done in GP surgeries, doing it yourself at home is risky. If there is an unrecognised hole in the eardrum, irrigation can flood the middle ear and cause infection, dizziness, or hearing loss. It is much safer to come and have the ear looked at properly first.

When should I see someone about my wax?

It is worth being seen if you have:

Hearing loss or muffled hearing on one or both sides that you suspect is wax
A blocked or full feeling in the ear that doesn't settle with softening drops
Pain, discharge, or itching in the ear
Wax problems alongside dizziness or ringing in the ear
Difficulty fitting hearing aids because of recurrent wax
Recurrent wax build-up despite home measures

You should be seen sooner if symptoms have come on suddenly, or if you are worried that something other than wax might be going on. A sudden hearing loss is rarely just wax (there is more on this on my Hearing Loss page) and needs urgent assessment.

Is it actually wax? Why a proper examination matters

A blocked or full feeling in the ear is not always wax, even when it really feels as though it must be. The same sensation can be caused by Eustachian tube dysfunction (when the small tube that ventilates the middle ear isn't working properly), middle ear fluid behind the eardrum, hearing loss for other reasons, or sometimes more involved problems sitting deeper in the ear. Patients often arrive convinced the ear just needs a clean and are surprised when the underlying problem turns out to be something else entirely.

This is why I think it matters who you see for wax. The various high-street wax removal services do a perfectly good job of taking wax out, but they are not set up to give you a proper ENT examination of the ear behind it. If the wax has been hiding the problem, you may walk out with a clean ear canal and the original symptoms still there, with no real explanation of why.

In my appointments, removing wax is sometimes part of the visit rather than the whole point of it. Wax often has to be cleared first simply so that I can see the ear properly, but the goal is always a thorough examination once the canal is clear, not just the wax removal itself. Under the microscope I will look at the entire eardrum, including the upper part (the attic, the section sitting just above the main eardrum). This bit is easy to miss on a quick look and is exactly where some of the more important ear conditions, including early cholesteatoma, can hide. A complete examination of the eardrum and the canal beyond it is part of every wax appointment I do, not an extra step.

It is not unusual to find something more behind the wax. An ongoing ear infection, an underlying hole in the eardrum, or in some cases an early cholesteatoma can sit hidden under a wax build-up, and the wax may even be the only reason the patient finally came in. These are exactly the situations where the diagnosis can easily be missed in a short, wax-only appointment, and they are the main reason I think a thorough review of the ear is worth doing every time, even when the patient's only complaint is that they think they have wax.

I also have a small camera I can use in clinic to show you what I'm seeing inside your own ear. Most patients have never had a proper look at their own eardrum, and being able to see the canal, the eardrum, and any pathology on the screen makes a real difference. It helps explain why I'm recommending a particular treatment, makes any abnormal findings easier to discuss, and means you leave the appointment with a clearer understanding of what's actually going on rather than having to take my word for it.

If you have ongoing ear symptoms and you've already had wax removed elsewhere without anyone really getting to the bottom of it, it is well worth being seen by someone who can do both jobs in one visit.

What does ear wax removal in clinic involve?

Wax removal in clinic is done gently, under direct vision through a high-magnification operating microscope, so I can see exactly what I am doing throughout. The skin of the ear canal is sensitive and easily irritated, which is why a careful, unhurried approach matters as much as the equipment itself.

Microsuction, using a fine suction tube to lift soft or fragmented wax out, is the technique most patients have heard of and it is what I use most often. But it isn't the only tool. Depending on the size of the wax, how hard it is, where it is sitting, and whether the patient has had previous ear problems, I may also use:

A small wax hook, which can lift out a hard, well-defined plug in one piece without needing to suction at it for any length of time
Fine crocodile forceps, which are useful for grasping and removing larger or firmer pieces, or wax that is dry and flaky
A combination of the above. It is fairly common for me to use two or three different instruments in the same ear, choosing whichever is most appropriate for the bit of wax I am dealing with at the time

The technique used depends on the wax, not on a fixed protocol. Soft wax usually comes out easily with suction. Hard, dry wax is often better lifted with a hook or forceps. A combined approach is often the quickest, most comfortable, and least irritating for the ear.

There is no water involved with any of this, which is what makes it suitable for patients with a hole in the eardrum, a grommet, a previous ear operation, or any history of ear infections.

What to expect:

The procedure is quick. Most patients are done in 5 to 15 minutes.
It is generally painless. You will hear the sound of the suction, which can feel a little odd, but it should not hurt.
You may notice a slight fluttering or vibration sensation as the suction passes near the eardrum, and a brief whoosh of cold air. Both are normal.
The hearing usually improves immediately afterwards, often dramatically if the canal was completely blocked.
Occasionally the suction noise can leave a temporary mild ringing in the ear that settles within a few minutes.

If the wax is very hard, I may suggest using softening drops for a few days before the appointment to make removal quicker and more comfortable. I will tell you in advance if that's a good idea for your particular situation.

This combined microscopic approach is generally a much better and safer option than ear syringing or ear irrigation, both of which involve flushing water into the canal.

What about ear irrigation?

Ear irrigation (sometimes still called syringing, although modern irrigation uses a low-pressure pump rather than a syringe) involves flushing warm water into the ear canal to dislodge wax. It can work for some patients, but it is not as controlled as microsuction, and it should not be done if there is any history of a hole in the eardrum, ear surgery, grommets, recurrent ear infections, or dizziness. If a hole in the eardrum is missed, irrigation can cause an infection, dizziness, or rarely a more serious inner ear injury. For these reasons I generally recommend microsuction over irrigation in most situations.

What about a narrow ear canal? Meatoplasty

A small number of patients have an ear canal that is unusually narrow, either as a feature they were born with, or because of long-standing inflammation, exostoses (small bony outgrowths in the canal, sometimes seen in keen swimmers and surfers), or previous ear surgery. A very narrow canal makes wax problems much more likely, makes the ear harder to clean even in clinic, and can also make it difficult to fit hearing aids.

In selected patients, an operation called a meatoplasty can widen the bony or cartilaginous opening of the ear canal to make these problems easier to manage. It is not a frequent operation, but it can make a real difference to the right patient. If you have struggled with recurrent wax for years, repeated infections in a narrow canal, or have been told your canals are too tight to fit a hearing aid, this is worth a proper conversation. I will assess the ear under the microscope and we can discuss whether it might be helpful in your case.

When should you come and see me?

Come and see me if:

You have ongoing or recurrent wax problems that home measures aren't sorting out
You have a hearing aid and want a thorough wax assessment from someone who can also examine the ear properly
You have a hole in the eardrum, a grommet, or any history of ear surgery, and want safe wax removal that doesn't involve water
You have a narrow ear canal and have been told you may need a meatoplasty, or simply want to know if you are a candidate
You have any concerns about your ear that go beyond wax and would like an experienced ENT opinion

I'll examine your ears under the microscope, remove any wax that needs removing, and give you a clear plan for keeping things in good shape going forward.

Helpful resources

Disclaimer

This page is intended as general information only. It does not replace a consultation, examination, or individual medical advice. If you have an ongoing wax problem, or are unsure whether your symptoms are due to wax, please get in touch to book an appointment so I can examine your ear properly and give you advice specific to your situation.

I have no financial interest in any of the products mentioned on this page. They are simply options that I and my patients have found helpful, and there are many other reasonable alternatives.