Health Information

Symptoms

• Too much earwax can cause rubbing of the ear or poking in the canal.
• A piece of ear wax can become dry and hard in the ear canal. This creates a feeling that an object is in the ear and can cause ear pain.
• Your child might have difficulty hearing if there is a complete blockage of the ear canal.
• A large piece of earwax may be seen inside the ear canal.

Causes

• Some children normally produce more wax than others. It usually will come out on it’s own if it’s not pushed back in.
• Things like cotton swabs, fingers and ear plugs can push wax deeper into the canal.

Earwax is Normal

• Everyone has earwax.
• Earwax is made by glands in the outer third of the ear canal.
• New earwax can be soft and a golden-yellow color. Older earwax becomes dryer and turns to a brown or black color.
• Earwax is not dirty or a sign of poor hygiene.
• Earwax protects the skin lining the ear canal. It is a natural water-proofing agent.
• Earwax also has germ-killing properties.

Ear Canals are Self-Cleaning

• Ear canals are designed to clean themselves.
• The ear canal skin slowly moves out of the ear canal. It carries the earwax along with it. The wax dries up and becomes flaky. It falls out of the ear on it’s own.
• Earwax only needs to be removed from inside the ear if it causes symptoms – such as trouble hearing (this can be observed in your daily life or discovered when your child fails their hearing test at their check-up) and pain.

Problems From Using Cotton-Tipped Swabs

• The cotton-tipped swab pushes the wax back in. The earwax then builds up and causes symptoms.
• Water can accumulate behind the wax build-up, leading to swimmer’s ear.
• If all of the ear wax is removed, the ear canals become itchy.
• Cotton swabs cause over 10,000 ear injuries each year in the US. Over 2,000 are punctured eardrums.

Prevention of Blocked Ear Canals

• Never put cotton-tipped swabs into the ear canal.
• Earwax doesn’t need any help getting out. You can’t hurry the process.
• Never try to dig out pieces of earwax with toothpicks, match sticks or other devices. Usually, doing this just pushes the wax back in.
• Limit the use of ear plugs.

Care Advice

1. Overview:
   • In general, leave earwax alone.
   • It will come out and fall away on its own
   • You can clean the wax that has come out of the canal with a washcloth.
   • Nothing smaller than your finger (some doctor’s even say your elbow) should go inside the ear unless your child’s healthcare provider has directed you otherwise.
2. Reasons to Flush out the Ear Canal:
   • Earwax is completely blocking an ear canal and your child can’t hear on that side.
   • If the hearing seems normal on that side, the blockage is only partial. You can leave it alone.
   • Sometimes, you and your child’s physician will decide to flush your child’s ear out
     • Only attempt to do this at home if your child’s healthcare provider has instructed you how to do this
     • When done in the office, we squirt lukewarm water into the ear to remove the wax. Sometimes the water is mixed with hydrogen peroxide. Sometimes docusate will be put in the ear first – this medication is often used for constipation, but can also help soften the ear wax prior to flushing the ear.
3. Ear Drops - Use for 4 Days to Soften the Earwax:
   • If the earwax is hard, soften it before flushing the ear canal. Use ear drops to break up the earwax.
     • Lie on the side with blocked ear upward.
     • Place 5 drops into ear canal.
     • Keep drops in ear for 10 minutes.
     • Then lie with the blocked side down and let the ear drops run out on some tissue.
     • Use twice daily for up to four days.
   • Do NOT use ear drops if your child has a hole in their eardrum or if they have ear tubes.  
   • STOP using ear drops if pain occurs. 

Call Your Doctor If

• Your child has pain
• Your child has persistent trouble hearing
• Your child has fever
• Your child has discharge or drainage from the ear canal
• You think your child needs to be seen
• Your child becomes worse

This publication was adapted from information within American Academy of Pediatrics Patient Education Handouts

Reviewed by:  TT D.O, AR D.O.  | 06/2023