The accumulation of cerumen (earwax) causes a blockage in the ear canal known as cerumen impaction. Cerumen is normal and protects the ear. 

Earwax is mixture of secretions and sloughed cells. Skin cells transport earwax from inner ear to canal entrance as they gradually develop and renew. 

The two main types of earwax are: 

Wet (sticky and brown) 

Dry (flaky and gray) 

Symptoms of earwax include pain, hearing loss, tinnitus, and dizziness. In older individuals the earwax turns hard in nature to causes excessive ear complications. 

Repeatedly placing objects in the ear can cause impacted earwax in kids and young people without ear canal issues. 

Impacted cerumen affects 10% individuals of the population. It is seen more in children with prevalence rate of 10% to 30%.  

It also occurs in older adults, with a prevalence of 34% due to age-related factors and hearing aids. 

Disabled individuals have higher risk of earwax buildup. It is noticed in developing countries due to healthcare and hygiene limitations. 

Earwax is produced due to ceruminous and sebaceous glands in ear canal. It contains lipids, proteins, microorganisms, and dust particles. 

Earwax usually exits the ear canal due to jaw movements and skin cell migration. Objects like cotton swabs, hearing aids, and earplugs can push earwax deeper into canal. 

Excessive earwax production due to genetics, skin conditions, or gland activity can overwhelm ears natural clearing mechanisms.
Ear canal shape, hair, or blockages can prevent earwax from moving out, that causes buildup due to disrupted migration process. 

Causes of earwax are: 

• Use of cotton swabs 
• Bony blockage 
• Infectious disease 
• Skin disease 
• Autoimmune disease 
• Narrowed ear canal 
• Inadequate Ear Hygiene Practices 

Children and elders more prone to earwax blockage due to anatomy. 

Curved or narrow ear canals can lead to frequent earwax blockages for some people. 

Earwax texture depends on age and hydration, while dry and hard wax is harder to remove. 

Skin conditions like eczema, psoriasis, and seborrheic dermatitis can cause ear canal issues and impacted earwax. 

History of earwax blockage predicts future issues, especially for those with past occurrences. 

Collect detailed patient history with symptoms, causes, and factors to help in diagnose and management of cerumen impaction. 

Visual Inspection 

Hearing Assessment 

Assessment of Impaction 

Acuity depends on blockage extent, wax consistency, and any related complications. 

Mild to Moderate Symptoms are: 

Mild Hearing Loss 

Ear Fullness or Discomfort 

Acute symptoms are: 

Significant Hearing Loss 

Pain 

Dizziness or Vertigo 

Monitoring without intervention may be suitable for patients with mild symptoms and intact ear canal. 

Use of cerumenolytic agents to soften earwax is recommended for easier removal.  

Advise patients to use ear drops as directed with a few drops in the affected ear once/twice daily for some days. 

Warm water irrigation technique is performed using a syringe or specialized irrigation device to exit softened cerumen. 

Curettage technique use a curette or other specialized instruments to manually remove cerumen under direct visualization/light. 

Examine ear canal and eardrum post cerumen removal for completeness. 

Otolaryngology

Avoid using cotton swabs or objects, which can push wax deeper. Ear drops soften earwax for easier natural expulsion when regularly used. 

Clean outer ear gently with soft cloth and let ear self-clean naturally for hygiene.
Regularly clean and maintain hearing aids to prevent cerumen buildup and use less cerumen-prone devices. 

In environments with high dust or debris patient should use protective ear coverings to minimize earwax accumulation. 

Use earplugs when swimming and thoroughly dry ears to prevent cerumen impaction for prone individuals. 

Ophthalmology

Carbamide Peroxide: 

It is used to soften cerumen and allow easy removal from the ear either naturally or through irrigation. They are available in the form of ear drops.  

Otolaryngology

Ear irrigation technique is suitable for cases where the cerumen is softened and not impacted too deeply. 

Manual Removal i.e. curettage technique is used in appropriate cases where cerumen is compacted or when irrigation is contraindicated. 

In some severe cases microsuction technique is effective to remove deeply impacted wax or in patients with a perforated eardrum. 

Otolaryngology

In the initial assessment phase, evaluation of patient history, physical examination and hearing assessment to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes use of Cerumenolytic agent. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies. 

The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.