Earwax Buildup

Is this your child's symptom?

• Earwax (cerumen) buildup or blockage
• Questions about earwax removal

Symptoms of Earwax Buildup

• Too much earwax can cause rubbing of the ear or poking in the canal.
• A piece of ear wax can become dry and hard in the ear canal. This creates a feeling that an object is in the ear.
• Complete blockage (plugging) of the ear canal by wax causes more symptoms. These include decreased or muffled hearing.
• A large piece of earwax may be seen inside the ear canal.

Causes of Earwax Buildup

• Cotton Swabs. Earwax buildup is usually from using cotton swabs. They push the wax back in and pack it down.
• Fingers. A few children (perhaps 5%) normally produce more wax than others. It usually will come out if it's not pushed back by fingers.
• Ear Plugs. Wearing ear plugs of any type can also push wax back.

Earwax is Normal

• Everyone has earwax. Earwax is normal and healthy. Earwax is not dirty or a sign of poor hygiene.
• Earwax is also called cerumen.
• Earwax is made by special glands in the outer third of the ear canal.
• Earwax has a purpose. It protects the skin lining the ear canal. It is a natural water-proofing agent.
• Earwax also has germ-killing properties.
• New earwax is soft and a golden-yellow color.
• Older earwax becomes dryer and turns to a brown or black color.

Ear Canals are Self-Cleaning

• Ear canals are designed to clean themselves.
• The ear canal skin slowly moves out of the ear canal. It carries the earwax along with it. The wax dries up and becomes flaky. It falls out of the ear on its own.
• There are some people who produce much more earwax than others. For such people periodic ear cleaning may be needed.
• Earwax only needs to be removed from inside the ear if it causes symptoms. Examples of symptoms are decreased hearing, discomfort, fullness or blockage.

Problems from Using Cotton-Tipped Swabs

• The cotton-tipped swab pushes the wax back in. The earwax builds up and causes symptoms.
• Ear canal blockage
• Decreased or muffled hearing.
• Trapped water behind the wax (can lead to Swimmer's Ear).
• Itchy or painful canals, especially in teens who often use Q-tips. A dry ear canal is always itchy.
• Sometimes, bleeding or damage to the eardrum.
• Cotton swabs cause more than 10,000 ear injuries each year in the US. More than 2,000 are punctured ear drums. Never allow young children to play with cotton swabs.

Prevention of Blocked Ear Canals

• Never put cotton swabs (cotton buds or Q-tips) into the ear canal.
• Cotton swabs just push the earwax deeper into the ear canal. Reason: Cotton swabs are usually wider than a child's ear canal.
• Earwax doesn't need any help getting out. You can't hurry the process.
• Never try to dig out pieces of earwax with toothpicks, match sticks or other devices. Usually, doing this just pushes the wax back in.
• These objects can also scratch the ear canal and cause an infection.
• If all of the ear wax is removed (as with cotton swabs), the ear canals become itchy. They also become more prone to swimmer's ear. This can occur in teens when cotton swabs are smaller than the ear canal.
• Limit the use of ear plugs.

When to Call for Earwax Buildup

Call Doctor or Seek Care Now

• Ear pain or bleeding after object (such as cotton swab) was inserted into ear canal
• Ear pain after ear canal flushing to remove wax and it's severe
• Walking is very unsteady
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Ear pain after ear canal flushing and it lasts more than 1 hour
• Pus (yellow or green discharge) from the ear canal
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• History of ear drum perforation, tubes or ear surgery. Reason: don't remove wax at home.
• Complete hearing loss in either ear
• Age less than 6 years with earwax problems
• Earwax problems not better after using Care Advice
• You don't want to try to remove earwax at home
• You have other questions or concerns

Self Care at Home

• Questions about earwax removal

Care Advice for Earwax Buildup

1. What You Should Know About Earwax Buildup:
   • Earwax is good.
   • In general, leave earwax alone.
   • It will come out and fall away on its own.
   • If you see some wax right at the opening, you can flick it away. Use something that won't push it back in, such as a paper clip.
2. Reasons to Flush out the Ear Canal:
   • Earwax is completely blocking an ear canal and can't hear on that side.
   • If the hearing seems normal on that side, the blockage is only partial. You can leave it alone.
3. Age 6 Years and Older - Ear Canal Flushing with Water:
   • Under age 6, use only if advised by your child's doctor.
   • Buy a soft rubber ear syringe or bulb from the pharmacy. No prescription is needed.
   • Have your child lean over the sink. Reason: To catch the water.
   • Use lukewarm water (body temperature). Reason: To prevent dizziness.
   • Gently squirt the water into the ear canal. Then tilt your child's head and let the water run out. You may need to do this several (3-4) times.
   • If the earwax does not seem to be coming out, tilt the head. Then, flush it with the head tilted. Have the ear with the wax in it facing downward. Gravity will help the water wash it out (the waterfall effect).
   • Endpoint: Flush until the water that comes out is clear of wax. Also, the ear canal should be open when you look in with a light.
   • Afterwards dry the ear thoroughly. You can do this by putting a drop of rubbing alcohol in the ear canal. Or you can set a hair dryer on low. Hold it a foot away from the ear for 10 seconds.
4. Caution - Ear Canal Flushing:
   • Do not perform flushing if your child has a hole in the eardrum or ear tubes.
   • Stop flushing if it causes pain or dizziness.
   • Do not use a water jet tooth cleaner (such as a WaterPik) for ear flushing. Reason: The force of the jet can cause pain.
5. Ear Drops - Use for 4 Days to Soften the Earwax:
   • If the earwax is hard, soften it before flushing the ear canal. Use ear drops to break up the earwax.
   • Homemade ear drops: 15% baking soda solution. Make it by adding ¼ teaspoon (1.25 mL) of baking soda to 2 teaspoons (10 mL) of water.
   • Other option for homemade ear drops: hydrogen peroxide and water solution. Mix equal parts of each.
   • Drug store option: Earwax removal ear drops (such as Debrox). No prescription is needed.
   • Use 5 drops in affected ear, 2 times daily, for 4 days.
6. How to Put in Ear Drops:
   • Lie on the side with blocked ear upward.
   • Place 5 drops into ear canal.
   • Keep drops in ear for 10 minutes by continuing to lie down.
   • Then lie with the blocked side down. Let the ear drops run out onto some tissue.
   • Use twice daily for up to four days.
   • Then flushing should be able to get everything out.
7. Cautions for Ear Drops:
   • Do not use ear drops if your child has a hole in the eardrum. Also do not use them for children with ear tubes.
   • Stop using ear drops if pain occurs.
8. Earwax Removal Before 6 Years Old:
   • Earwax removal in this age group can be hard.
   • Removal may not be needed. The ear wax should come out on its own. Don't use cotton swabs.
   • Do not use eardrops or ear flushes unless it is advised by your child's doctor. This also can be done in your doctor's office.
9. Call Your Doctor If:
   • Flushing out the ear canal doesn't return the hearing to normal
   • Earache occurs
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/11/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.