Earwax removal

Wax blocking the ear is the commonest cause of temporary deafness in adults. Earwax is a normal physiological substance in the ear canal. It is produced by ceruminous glands, which are modified sweat glands lying within the ear canal. The wax (cerumen) aids removal of skin debris and dirt from the ear canal and cleans, lubricates and protects the lining of the ear canal; it also has antibacterial properties.

Wax is usually soft and works its way out of the ear, but an excessive build-up of hard earwax with hair and skin debris can develop in some people. Cotton wool buds, or other things like match sticks, should never be poked into the ear to clean or clear it as this just pushes the wax further in and it is possible to damage the eardrum.

The ear can often be unblocked by using ear drops, which softens wax and may allow it to run out. Many people who have recurrent problems with wax, recognise the symptoms and will purchase these drops to help prevent build-up. If this is not adequate to clear the problem, the ear drops will usually have softened the wax enough to enable removal using electronic irrigation or microsuction. In some people with complicated ear problems, removal of wax by ENT specialist is necessary.

Many private earwax removal services in the UK now use microsuction. Ear syringing is no longer recommended. A small probe (like a mini vacuum cleaner) is inserted into the ear canal and low-pressure suction is used with no need for water.

Following earwax removal, the ear should be examined with an otoscope (or microscope) to check that the wax has been fully removed and that the eardrum is unharmed. There are very rarely complications but if severe pain, deafness, or vertigo occurs during or after irrigation, or if an acute perforation is seen following the procedure, seek immediate medical advice.

Conclusion

Community pharmacy teams have already shown that they are capable of conducting ear examinations, assessing whether onward referral is needed, and offering treatment for acute otitis media.

A logical next step is the extension of community pharmacy involvement in ear health to the benefit of patients who currently have long waits to access assessment for suspected hearing loss, and treatment for impacted earwax. This module will help pharmacy teams to prepare for future services.

• This module draws on material from a chapter in the new (10th) edition of Symptoms in the Pharmacy: A guide to the management of common conditions and disease prevention published in March 2025.