Earwax (also called cerumen) is a natural mix of skin cells and oily secretions made in the outer part of the ear canal. Its job is protective: it helps lubricate the canal, traps dust, and can reduce irritation and infection risk. In most people, earwax slowly moves outward on its own — helped by jaw movement — and flakes away naturally. Because of that self-cleaning process, routine “deep cleaning” is usually unnecessary and can backfire.

Wax becomes a medical issue when it turns into cerumen impaction, meaning wax has built up enough to cause symptoms or block a clinician’s view of the ear canal or eardrum. Proven symptoms linked to impaction include hearing loss, ringing (tinnitus), a blocked/full feeling, itching, pain, discharge/odor, and sometimes cough.

Impaction is common: it has been reported in about 10% of children, 5% of healthy adults, and much higher rates in older adults and people with developmental or cognitive impairment. Hearing aids can also increase wax build-up and interfere with wax migration, so periodic ear checks are recommended for hearing-aid users during healthcare visits. Importantly, clinical guidelines advise that clinicians should not routinely remove wax if a person has no symptoms and the ear can be examined normally — because “normal” wax is often doing useful work.

When removal is truly needed, evidence-based options include cerumen-softening drops (cerumenolytics), irrigation, and manual removal with instruments. Studies and reviews generally show that softening drops are better than doing nothing, but no single drop type has clearly proven superior across the evidence.

Irrigation can be effective, including selected adults using a bulb syringe at home with proper instructions, but it carries risks: complications such as eardrum perforation, canal injury, infection, bleeding, dizziness, or fainting are uncommon yet real, with major complications estimated at roughly 1 in 1,000 irrigations in some reports.

Certain groups need extra caution or referral (for example, non-intact eardrum, prior ear surgery, ear canal narrowing, diabetes, immunocompromise, or blood thinners). Clinicians also strongly recommend against unsafe methods like cotton swabs inserted into the canal, ear candling, and “jet irrigators” for self-treatment, which can injure delicate ear structures or push wax deeper.