American Academy of Otolaryngology Practice Guidelines: Manage cerumen impaction with cerumenolytics like carbamide peroxide drops (5–10 drops twice daily for up to 4 days) to soften wax, followed by ear canal irrigation using body-temperature saline or water. Avoid ear candling, cotton-tipped swabs, and jet irrigators, as these can worsen impaction or cause injury. For persistent or severe cases, seek professional removal using curettes, suction, or microsuction.
January 9, 2025

Earwax Blockage: At-Home vs Doctor's Office

Evidence-Based Over-the-Counter Guide

William Shen

William Shen

Co-founder & CPO

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This guide is based on the 2017 American Academy of Otolaryngology clinical practice guideline update. 

Cerumen impaction occurs when excessive earwax blocks the ear canal, potentially causing discomfort, hearing loss, or infection. These first-line recommendations are for those without prior ear surgery, which increases risk of eardrum rupture. 

First-line recommendations:

  • Cerumenolytics: Carbamide peroxide 6.5% drops: Instill 5-10 drops into the ear twice daily for up to 4 days. Debrox Ear Wax Removal Drops.

  • Ear canal irrigation: Use body-temperature saline or water to flush the ear canal, preferably after softening the wax with cerumenolytics. Do not use cold or hot water as this can trigger an extremely uncomfortable reflex. Manual Ear Irrigation Flushing System.

Professional interventions:

  • Manual removal: Performed by healthcare providers using curettes or suction to remove hardened wax.

  • Microsuction or endoscopic removal: Professional procedures to safely and effectively clear the blockage, especially for patients with narrow or sensitive ear canals. Do not attempt at home.

Prevention given previous impaction:

  • Periodic cleaning: Occasional softening and cleaning using irrigation from a bulb syringe can be helpful. Debrox Ear Wax Removal Kit with Bulb Syringe.

  • Monitoring: Using an electronic otoscope camera to self-monitor for earwax can be helpful. Manual removal of earwax is not recommended due to risk of eardrum perforation or worsened compaction. Electronic Ear Camera.

Not recommended: 

  • Ear candling, olive oil drops, cotton-tipped swabs, and at-home use of jet irrigators are not recommended for cerumen removal as these may damage your ear, cause worsened earwax blockage, and even perforate your ear drum.

Citation:

Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical Practice Guideline (Update): Earwax (Cerumen Impaction). Otolaryngol Head Neck Surg. 2017; 156(S1). doi: 10.1177/0194599816671491

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