Earwax is produced by tiny sweat glands in your ear canal, known as ceruminous glands. The earwax forms a protective coating inside your ear canal that traps dust and other tiny objects, preventing them from getting into the delicate interior of your ear.

Earwax plug
Some people produce more earwax than others. It usually falls out of your ear gradually, in small pieces, or flakes. However, in some cases, earwax can build up, harden, and form a blockage, called a plug. If you have an earwax plug, it can cause slight discomfort, and a loss of hearing as your ear canal becomes blocked. Hearing loss is often blamed on earwax but, in some cases, it may be caused by something else. However, if you do have an excessive amount of earwax, any hearing impairment that you have may be improved once the blockage is removed.

Discomfort and earache
As well as a physical feeling that something is blocking your ear, if you have a build up of earwax, you may experience the following symptoms:
- discomfort in your ear,
- earache,
- tinnitus - noises in your ear,
- itchiness,
- vertigo - the sensation that you are spinning even when you are standing still, and
- a cough - caused by the stimulation of a nerve inside your ear due to the pressure of the impacted earwax. However, this is rare.

People who produce a lot of earwax are more likely to experience a blockage in their ear than those who only produce a small amount. Your risk of developing problems as a result of a build up of earwax are also increased if you:
- have narrow or deformed ear canals,
- have a lot of hair in your ear canals,
- have benign (non-cancerous) bony growths in the outer part of your ear canal,
- have a dermatological (skin) condition of your scalp or peri-auricular area (the area just in front of your ear lobe),
- have hard wax, as it is more likely to become impacted,
- are elderly because as you get older, your earwax becomes drier,
- have a history of recurrent impacted earwax, and
- have learning difficulties (the reason for this is unknown).

If you produce a lot of earwax, further blockages are likely to occur, even after you have had a plug removed by your GP or practice nurse. Further blockages are also likely if you have particularly narrow ear canals that become blocked more easily.
If you use cotton buds, your earwax may become impacted because they can push earwax deeper into your ear canal, packing it harder together and creating a plug. Wearing a hearing aid or earplugs can also increase the chances of earwax becoming impacted because they may stop the wax from being excreted (falling out of your ear naturally).

No tests are necessary to confirm the presence of earwax. However, if you have problems as a result of earwax, your GP or a specialist may examine both of your ear canals using an instrument called an auriscope. They will be able to see if wax is present, and whether or not it appears to be impacted.

If you have hearing loss, it may be the result of impacted earwax. Hearing loss can be detected using a number of tuning fork tests. 

Rinne test - The Rinne test involves placing a vibrating tuning fork at different points of your ear, usually the external auditory meatus (the entrance to the ear canal) and the mastoid bone (behind the ear lobe). You will be asked to say which one sounds the loudest so that the tester can determine whether you are more able to pick up sound via air conduction or bone conduction. 

Weber test - In the Weber test, the vibrating tuning fork is placed on the middle of your forehead. As with the Rinne test, the Weber test will enable the tester to determine whether your hearing loss is sensorineural (sound loss through the air), conductive (sound loss through bone), or whether it is a combination of both. 

If there is a combination of both sensorineural and conductive hearing loss, the results of the tuning fork tests may be unreliable. As well as a build up of ear wax, hearing loss may be caused by a number of other conditions including: 
- otitis externa - inflammation of the external ear canal as a result of allergy or infection, 
- foreign bodies - a common cause in children,
- keratosis obturans - a rare condition where an excess of keratin (a fibrous substance containing protein) produces a dense, pearly white plug in the external ear canal which, in some cases, can erode the bony canal.

In the majority of cases, earwax falls out on its own without the need to remove it. However, if earwax is totally blocking your ear, it may need to be removed.
 
If you have a build up of earwax that becomes impacted and forms a plug, treatment to remove it may be recommended.  Initially, ear drops to soften the plug may be used. Click on the link to view the treatments available from Treat Discreet; Otex Express Combi Pack & Otex Ear Drops.

If ear drops do not work, a process known as irrigation may be required.
Sometimes, earwax may also need to be removed in order to make an impression of the ear canal for a hearing aid mould, or if the earwax is causing the hearing aid to whistle.

Ear drops
Your GP or a specialist may prescribe ear drops to soften your earwax, making it easier to remove. Ear drops containing sodium bicarbonate (5%), sodium chloride (0.9%), and olive oil or almond oil may be prescribed for 3-5 days to soften the wax. If you have a perforated ear drum, eardrops will not be prescribed.
Ear drops should always be used when they are at room temperature. Pour a few drops into the affected ear, and lie on your side for a few minutes with the affected ear facing upwards. This will allow the ear drops to soak into the wax and soften it. If you repeat this 2-3 times a day for between 3-5 days, the plug should soften and may gradually fall out of your ear bit by bit.

Ear irrigation
If after using ear drops the earwax blockage persists, irrigation may be recommended.
Irrigation involves using a pressurised flow of water to remove the build-up of ear wax. Nowadays, an electronic ear irrigator should always be used, rather than a metal syringe to avoid causing damage to the ear. The irrigator has a variable pressure control so that syringing can be started at the minimum pressure.
You will usually be sitting down during the procedure while a health professional squirts a controlled flow of water (which is around body temperature) into your ear canal in order to 'clean' out the ear wax. The person may hold your ear at different angles in order to straighten your ear canal to ensure that the water jet reaches all areas. During the procedure, the health professional will look inside your ear a number of times using an auriscope (instrument for examining the ear) to check whether the wax is coming out.
The irrigation procedure is painless, but you will usually experience a strange sensation in your ear as the water jet is squirted around your ear canal. Tell the person who is irrigating your ear, if you experience pain, dizziness, vertigo, or hearing loss during the irrigation procedure.
If irrigation proves unsuccessful at removing your earwax, your GP may recommend one of the following:
- using ear drops for a further 3-5 days and then returning for another irrigation,
- placing water into the ear before irrigating and again 15 minutes after, or you may be referred to an ear, nose and throat specialist (ENT) for removal of the wax.

Ear irrigation is not suitable for everyone
Ear irrigation is not suitable for everyone and should not be used if you have:
- had previous problems with irrigation, such as pain or perforation,
- perforation of the tympanic membrane (eardrum),
- a history of perforation of the tympanic membrane in the last 12 months,
- a mucus discharge from your ear (which may indicate an undiagnosed perforation within the last 12 months),
- had a middle ear infection in the previous six weeks,
- a grommet. A grommet is a small, hollow tube that is sometimes surgically inserted into your ear if you have a build up of fluid that causes hearing difficulties. Ear irrigation is not recommended if you have a grommet because the grommet creates a passage in your middle ear, allowing water to enter during syringing,
- had any ear surgery within the last 18 months, apart from cases of extruded grommets. Grommets extrude (come out naturally) and the passage that was created by the grommet eventually heals. If you have had a grommet that has come out naturally and you have been discharged by the ENT department (ear, nose and throat) the passage will have healed. Therefore, you will be able to have your ear syringed if required. However, in practice, grommet surgery is most commonly carried out in children who do not have impacted earwax, and this situation is therefore rare,
- a cleft palate (whether repaired or not), or
- acute otitis externa (external ear infection) with a painful ear canal, or pinna (the visible part of your ear).

You should also not have irrigation if the ear to be treated is your only hearing ear, as there is a small chance that irrigation could cause permanent deafness. Young children who are uncooperative should also not have irrigation.
Other treatments for removing earwax
If your earwax cannot be removed using ear drops or irrigation, or if you are unsuitable for these treatments, a number of other treatment options may be considered including:
- microsuction - a technique that uses a gentle level of suction under a microscope. The procedure is noisy and may be uncomfortable, or
- aural toilet - under direct vision, the specialist will use an instrument known as a Jobson Horne probe to remove the wax.
Although there is no clinical evidence to show the effectiveness of mechanical methods of removing earwax (apart from irrigation), many ear, nose and throat specialists (ENT) regard microsuction as a routine treatment method.
If, after your earwax has been removed, you still have a hearing difficulty, your hearing will be retested. In some cases, it is possible for people who have a build up of earwax to have a hearing impairment that is not caused by the earwax itself. Therefore, removing the earwax will not relieve the symptoms of hearing loss, and the cause will need to be investigated further.