What causes ear wax build-up and how it can safely be removed

Did you know that our ear canal is a self-cleaning organ, and dead skin, hair and earwax are constantly moving out from it?

So the common use of cotton buds for cleaning ear wax tends to push it deeper into the ear canal, which may lead to a complete obstruction in some patients.

Consult a doctor if you experience earache, feel pressure or blockage in the ear, or suffer hearing loss, itchiness, dizziness or tinnitus.


Obstruction/Narrowing of the ear canal

Ear canal disease is one of the causes of the impedance of clearance of wax, and can be secondary to bone damage such as osteoma (benign bone growth) or skin conditions including infection of the external ear canal and eczema.

An ear canal that is tortuously narrowed either due to normal anatomical variations or repetitive injury and infections of the soft tissue ear canal has a higher risk of ear wax impaction.

Ineffective ear wax migration

The glands lining the ear canal shrink as we age. This produces more solid, less fluid-consisted wax. The wax clearance mechanism becomes inefficient.

Prolonged use of earplugs, hearing aids and swim moulds can potentially obstruct ear canals and contribute to the accumulation of ear wax.

Excessive ear wax

Excess ear wax can occur as a result of injury to the ear canal or water retention.


Cerumenolytic agents

This is a safe, convenient and effective option for patients without infective eardrum perforation and ear surgical histories.

However, one should follow up with a doctor for examination as prolonged retention of cerumenolytic drops behind the ear wax can lead to irritation of the skin lining of the ear canal.

Some patients have reported transient hearing loss, dizziness, ear pain and external ear canal infection. It is advisable to use cerumenolytics not more than three to five times a day.


Ear irrigation is one of the most widely-used methods, involving the flushing of water to remove the build-up of ear wax.

A common side effect of ear irrigation is the retention of water behind any wax that was not completely removed. This might result in an infection of the ear canal.

Manual removal

The procedure needs to be performed by an experienced clinician with appropriate equipment. It is a preferred option for patients with perforated eardrums or at high risk of sustaining an ear infection.

Manual removal procedures are most effective for removing ear wax in the ear canal.

Ear Toilet (Aural Toilet)

This is an ear cleaning procedure using "micro-suction" or a "mini-vacuum" tube to remove earwax in a safe manner.

With direct visualisation through a binocular microscope, doctors can clean the ear canal with greater precision and reduced patient discomfort.

Ear candling

This involves lighting one end of a hollow candle and putting the other end in the ear. However, it is not FDA (Food and Drug Administration)-recommended for ear wax removal as it is not safe and can cause injuries or burns.

The writer is a resident doctor at DTAP Clinic Raffles Place, with experience in Emergency Medicine, Family Medicine, Otorhinolaryngology (ENT), Venereology and Dermatology.