Earwax, also known as cerumen, is a waxy, yellowish substance found in the ear, produced by the sebaceous glands of the ear canal. It is primarily composed of desquamated skin cells. Earwax naturally serves to protect the inner ear wall from water, dust, fungi, insects, and bacteria that could enter the ear canal and damage the eardrum. It also cleans and lubricates the wall of the ear canal. If your ear did not produce earwax, your ear canal would not only be dry: it would also be waterlogged and exposed to all kinds of infections. As useful as it is to the ear, earwax that accumulates in excess eventually hardens. This can lead to various health problems, including tinnitus and hearing loss. The goal of this article is to determine if tinnitus is normal after earwax removal. But before we get to that, let's look at everything you need to know about earwax and the methods for removing it.
Causes of earwax buildup
An earwax plug, also known as a cerumen impaction, is caused by an excessive buildup of earwax. When the ear produces more earwax than necessary, the excess can harden and be pushed deep into the ear canal. Here are some causes of earwax buildup:
The use of hearing aids and earplugs. Constant wearing of hearing aids and earplugs can promote earwax buildup because they prevent desquamated skin cells from draining naturally.
Swimming. Frequent swimming can cause excessive earwax production. It is your ear's way of ensuring that water entering during swimming does not reach the ear canal.
The use of certain objects. Using objects such as keys, hairpins, corners of tissues or towels, and cotton swabs pushes the earwax deeper into the ear. Over time, the earwax pushed in this way accumulates and solidifies. These objects can also introduce germs into the ear, which will trigger increased earwax production intended to prevent them from reaching the ear canal.
People with a narrow or malformed ear canal are more prone to earwax plugs. People with bony growths in the outer part of the ear canal, the elderly, those with very hairy ear canals, and those suffering from skin conditions like eczema are also predisposed to them.
Symptoms of an earwax plug
When earwax builds up to excess and eventually blocks the ear canal, you will experience the following symptoms:
Ear pain: earwax buildup can cause pain in the ear. Its intensity varies from person to person.
Dizziness: the ear is responsible for both hearing and balance; when the ear canal is blocked, you may lose your balance, which results in lightheadedness and nausea.
Ear infection: as we mentioned above, the ear produces earwax to protect the inner ear from fungi, dust, bacteria, and anything that could cause an infection. But earwax buildup can produce the opposite effect and cause an infection. Accumulated debris can infect the ear.
Sensation of a blocked ear: when earwax builds up in excess, you may feel a sense of fullness in the affected ear. This is a very unpleasant sensation, which can hinder your hearing.
Tinnitus: tinnitus is the perception of sounds in the ear in the absence of any external noise. An earwax plug is one of the main causes of tinnitus. Accumulated earwax prevents the ear from functioning normally and causes it to generate sounds. In most cases, once the plug is removed, the tinnitus disappears.
How to remove an earwax plug
In this section, we will review the different ways to remove an earwax plug. We will categorize these methods into two groups: the medical approach and home treatments or remedies. This will then allow us to answer the question of whether or not earwax removal can cause tinnitus. Let's begin.
Home treatments and remedies
You can remove an earwax plug at home, but we advise you to do so with your doctor's approval. This will ensure that there is indeed an accumulation of earwax in your ear. This is essential, because the symptoms mentioned above are not specific to an earwax plug: they also accompany other pathologies. Dizziness, for example, is a common symptom of damage to the hair cells of the inner ear; likewise, a Eustachian tube problem can give a sensation of a blocked ear. During your consultation, the doctor will examine your ear to check for the presence of accumulated earwax; they can then recommend some of these home remedies to you.
1. Ear drops
This is one of the cheapest ways to get rid of excess earwax; these products can be bought over-the-counter or online. It is important to ask your doctor which drops to buy, as the market offers many products, branded or not. If you buy over-the-counter drops, be sure to follow the instructions on the packaging. Ear drops can be water-based or oil-based. Here are the different types of drops you can use to eliminate accumulated earwax.
Oil-based drops: the most common example is olive oil drops. This is one of the gentlest types of drops. The olive oil base softens the surface of the plug and loosens its edges, allowing the hardened earwax to slide outward more easily. Olive oil drops are gentle on the ears and well-tolerated by most people, but they may take a long time to work. To speed up the process, you may need to combine them with other methods. There is also a risk that the dissolved earwax will slide deeper into the ear canal instead of coming out.
Peroxide-based drops: some drops contain peroxide, specifically urea peroxide. This type of drop works by dissolving the earwax, which speeds up its removal. Peroxide-based drops contain a bleaching agent, which can cause a painful reaction upon the first application. Here again, there is a risk that the dissolved earwax will slide further into the ear canal.
Sodium bicarbonate drops: earwax is acidic, while baking soda drops are alkaline. Upon contact with the earwax, the drops trigger a chemical reaction that dissolves it. They act quickly: in a day or two, the plug is removed. The disadvantage of this type of drop is that prolonged use can destroy the protective layer of the ear canal and cause an infection. The dissolved earwax can also sink deeper into the ear canal.
If your eardrum is perforated, ear drops are not for you. It is also important to note that, in most cases, your hearing degrades before it improves when you use drops. If you suspect you have pushed the earwax deeper into the ear canal, contact your doctor immediately.
2. Hydrogen peroxide
This is another common method for removing earwax at home. Hydrogen peroxide can be bought over-the-counter or online. Earwax is removed by placing a few drops of hydrogen peroxide on a damp cotton ball that is applied to the affected ear. You can also instill it into the ear using a clean dropper. Be sure to tilt your head with the affected ear facing upward at the time of application. This will give the liquid time to flow into your ear and soften the earwax. After a few minutes, tilt your head to the other side so that the affected ear is facing downward; the softened earwax and liquid will then be able to drain out of the ear. If you do not let the liquid drain out, the situation may worsen.
3. Ear sprays
Ear sprays are placed at the entrance of the ear canal and sprayed to soften accumulated earwax. They are not only used to remove earwax: used once a week, they also prevent its accumulation. These sprays are either oil-based or water-based.
Oil-based sprays: these sprays rely on an oily base, such as olive oil. Not only are they cheap, but they also penetrate earwax more effectively than drops. Oil-based sprays reach deeper areas of the ear (further than drops). They are not always enough to remove earwax on their own; however, they can be used as a softener before other removal procedures.
Water-based sprays: these sprays have a base of sterilized seawater or saline solution. Gentle and well-tolerated by most people, they are ideally suited for small plugs. Their disadvantage is that the spray water can get trapped behind the plug and cause a sensation of a blocked ear. The force of the jet can also push the earwax further into the ear.
4. The ear syringe bulb
Earwax can be removed at home using a rubber bulb filled with lukewarm water. The water from the bulb is gently instilled into the ear with the head tilted and the affected ear facing upward. After a few minutes, turn the affected ear downward in order to drain the earwax and water. The operation should be repeated several times for optimal results.
This method is not suitable for people with a perforated eardrum. Be sure to use clean water that is neither too cold nor too hot. If water is sprayed with force into the ear canal, it can cause dizziness or push the earwax further into the ear.
5. Ear vacuums
Ear vacuums are designed to suck out earwax at home, but they are rarely effective. They are easy to find online, but they are not medical devices suitable for earwax removal. They are pleasant to use and emit a whirring sound while running, but that is about where it ends. When you remove the device from your ear, there may be a little earwax on it; do not see this as proof of its effectiveness. This earwax was not sucked out: it simply deposited on contact with the tip. Ear vacuums do more harm than good, as they push earwax deeper into the ear. The amount they extract is much less than what they push in.
6. Cotton swabs
The use of cotton swabs to remove earwax is very common. Although it may feel like they help remove it, in most cases, the cotton swab pushes the earwax deeper into the ear. Ironically, the use of cotton swabs is precisely one of the causes of earwax plugs. Earwax pushed in this way can press against the ear canal or the eardrum and cause pain, or even perforation. Even if the cotton feels soft on our hands, it is harsh on the ears. The skin of the ear canal is indeed very thin, and the cotton swab often scratches it, causing small bleeds. Cotton swabs may relieve itching, but they are not recommended for people who produce a lot of earwax. Because in addition to irritating the skin, they also stimulate earwax production.
7. Ear candles
Some people attempt to remove earwax at home using ear candles. This method is also called ear thermal therapy. It is very dangerous and can irreversibly damage the ear. Ear candles are made of paper and wax. A hollow fabric cone is coated with paraffin or wax, then inserted into the ear. The person must lie on their side with the affected ear facing upward. The cone is then lit. A cardboard plate is placed to prevent dripping wax from touching the skin. The candle is supposed to create suction that extracts earwax from the ear, but this is not the case. What most practitioners present as earwax extracted from the ear is not: it is the candle wax melted by the flame. This method is completely ineffective and should be avoided. Burning wax from the melted candle can fall onto the eardrum and perforate it instantly. It can also worsen the earwax plug. Ear candles can also cause bleeding, ear burns, severe pain, and permanent hearing loss.
The medical approach
These are earwax removal procedures performed by qualified doctors. You cannot perform them at home, as they require medical equipment. The doctor will need to examine your ears to confirm the presence of a plug before using these methods. Your medical history will also be taken into account; it will allow the doctor to determine the most appropriate procedure for your case.
1. Ear irrigation
This method is also called ear syringing. It is generally resorted to when drops do not work. In the past, a metal ear syringe was filled with lukewarm water, the tip was placed into the ear canal, and the water was injected into the ear. The water pressure was usually high in order to dislodge the plug. A container placed under the ear collected the evacuated water and earwax. Since the syringe had no regulator, the doctor or nurse relied on their judgment to determine the pressure to apply. Today, ear syringes have been replaced by electronic irrigators. With this device, the doctor can control the water pressure and adjust the temperature of the water injected into the ear. Irrigation or syringing alone is not enough to remove hardened earwax: it must be softened for at least two weeks before irrigation. The procedure is not painful, but it can cause discomfort. Ear irrigation is not recommended for the following people:
People who have undergone ear surgery within the last 12 months.
People born with a cleft palate.
Anyone with a perforated eardrum or who has had one in the past year.
People who have had a middle ear infection, such as otitis media.
Children with transtympanic tubes.
Although ear irrigation is painless, some complications can occur. The eardrum can be perforated if the water is too hot or the pressure is too strong. The risks of ear infection are high, especially since the force of the water can push earwax, bacteria, and water past the eardrum, into the middle ear. The procedure can also cause tinnitus. Because of these complications, many healthcare professionals are reluctant to use this method to remove earwax.
2. Micro-suction
This is the most effective method for removing earwax. Only properly trained doctors and nurses can perform it, as it requires good knowledge of ear anatomy and training in the use of the equipment. Micro-suction removes earwax without projecting any liquid; it can therefore be performed safely if you have a perforated eardrum or have been operated on recently. The procedure uses a microscope (on a stand or integrated into glasses) and a medical suction pump. The pump is connected to a tube equipped with a two-millimeter suction cannula. This cannula is used to suck the earwax out of the ear. The operation takes place under bright lighting. This light and the microscope allow the doctor to see exactly what is happening in your ear, making this one of the safest methods for removing earwax. The procedure is very fast, painless, and carries no risk of infection. If the earwax has not been softened beforehand, you may feel slight discomfort during the intervention. If the plug is very compact, a second consultation may be necessary.
3. Dry instrumental extraction / manual removal
This method is generally performed by a hearing care professional or an ENT surgeon. It consists of removing the earwax using instruments of various shapes called curettes. Curettes look like small loops or small spoons; they are used to scrape or hook the plug to extract it from the ear canal. The intervention takes place under lighting; some curettes even have their own built-in light. A microscope is necessary so that the doctor has a clear view of the ear. The earwax must be softened before the intervention so that the curettes can easily grasp it once inserted. Without prior softening, you risk feeling discomfort, and the earwax can, to a small extent, be pushed further into the ear.
Is tinnitus normal after earwax removal?
While earwax blockage can cause tinnitus, its removal can also trigger it. This does not mean, however, that earwax removal procedures systematically lead to tinnitus. Tinnitus can occur depending on the method used and the side effects it causes. Some home remedies that involve inserting objects into the ear canal (cotton swabs, for example) can damage sensitive ear tissues and cause tinnitus. Ear candles, for their part, can burn the ear and perforate the eardrum. The hair cells of the ear can also be destroyed; if this happens, you will experience tinnitus. Most of the methods we have reviewed tend to push the blockage deeper into the ear. However, impacted earwax can cause an inner ear condition, of which tinnitus is a major symptom. If the infection is not treated in time, it can spread to other parts of the head and lead to serious health problems, including cranial nerve paralysis. Furthermore, if the earwax is pushed back during an attempt to remove it, it can press against the tympanic membrane, i.e., the eardrum. It can also damage the hair cells of the inner ear, which causes vertigo, often accompanied by dizziness and nausea. Some drops and sprays used to soften and remove earwax are ototoxic, meaning they can cause tinnitus. If the damage to the ear is minimal, the tinnitus may be temporary; but if the spray or drops have been used for a long period, the tinnitus can become permanent. The irrigation method can also cause tinnitus. The pressure of the water jet, as well as the noise of the procedure, can be the cause. Sudden exposure to noise is one of the main causes of tinnitus; as this procedure is noisy, it can trigger or worsen it. The use of water that is too hot or not clean during irrigation can also introduce fungi or pathogenic bacteria into the ear, causing an infection. And ear infections can cause tinnitus. It is important to note that most of the methods we have reviewed do not remove all of the earwax and push some of it deeper into the ear. This explains why you still have tinnitus after the procedure. If earwax remains blocking your ear, the tinnitus will persist. Therefore, it is not necessarily due to damage caused by the procedure, but to the fact that its root cause, the earwax, has not been completely eliminated. Once the blockage is completely removed, the tinnitus subsides or disappears. As we have said, tinnitus is probably not what you expected right after having an earwax blockage removed. However, in most cases, if it occurs, it is not because earwax removal is a bad thing, but because the method used injured your ear. The safest way to remove earwax without risking the development of tinnitus remains micro-suction. It is the only method that has few or no side effects. If you opt for other methods such as ear candles, irrigation, syringing, cotton swabs, etc., you risk having tinnitus once the earwax is removed.
Conclusion
The best thing to do when you suspect an earwax blockage is to make an appointment with your ENT specialist: do not try to treat it yourself. The home treatments mentioned above should only be used on the recommendation and under the supervision of a doctor. If you have tinnitus after earwax removal, consult a doctor. They will examine your ear to determine if the tinnitus is due to earwax pushed to the back of the ear or if it is a side effect of the method you used. Have you ever had tinnitus after earwax removal? Which method did you use? Did the tinnitus disappear? Share your experience with us.
