Management of Impacted Earwax

Diagnosis and Treatment

The American Academy of Otolaryngology-Head and Neck Surgery recommends that cerumen impaction should be diagnosed when accumulation of cerumen causes symptoms such as decreased hearing, fullness, tinnitus, or distortion of hearing aid function 1
The American Academy of Otolaryngology-Head and Neck Surgery suggests that cerumenolytic agents should be applied for 3-5 days, followed by irrigation if needed, with manual removal by a healthcare provider as a third option when other methods fail 1, 2
The American Academy of Otolaryngology-Head and Neck Surgery recommends using water-based agents, such as acetic acid, sodium bicarbonate, hydrogen peroxide, or sterile saline, as cerumenolytic agents 3
The American Academy of Otolaryngology-Head and Neck Surgery indicates that irrigation is a second-line treatment, which can be performed by a healthcare provider or as self-irrigation at home with a bulb syringe 2, 4
The American Academy of Otolaryngology-Head and Neck Surgery advises that water should be at body temperature to avoid caloric effects during irrigation 3

The American Academy of Otolaryngology-Head and Neck Surgery states that contraindications to irrigation include history of tympanic membrane perforation, presence of tympanostomy tubes, history of ear surgery, active otitis externa, and susceptibility to ear infections 2, 5
The American Academy of Otolaryngology-Head and Neck Surgery recommends avoiding ear candling/coning, as it is ineffective and potentially dangerous 6, 2
The American Academy of Otolaryngology-Head and Neck Surgery advises against using cotton-tipped swabs, as they can push wax deeper and potentially cause injury 1, 5

The American Academy of Otolaryngology-Head and Neck Surgery suggests that preventive measures for patients with recurrent cerumen impaction include topical earwax-softening agents used periodically, self-irrigation with bulb syringe, and regular checking of the ear canal for cerumen in hearing aid users 4, 7

The American Academy of Otolaryngology-Head and Neck Surgery notes that rare but more serious complications of irrigation include tympanic membrane perforation (approximately 0.2% of irrigation cases) 5
The American Academy of Otolaryngology-Head and Neck Surgery warns that temporary dizziness may occur, particularly if water temperature differs significantly from body temperature 2