Cerumen Impaction (Ear wax Buildup)

August 2023 | Brian Chicoine, MD - Medical Director, Adult Down Syndrome Center

Key Points

Cerumen impaction is obstruction of the ear canal with ear wax.
It is a problem that is more common in people with Down syndrome.
There are treatments that can be done at home to prevent and/or treat the impaction.
Medical office procedures are often required in people with Down syndrome to remove the wax.

Video

Watch a video clip about ear wax build up opens in new window from our webinar At-Home Treatments for Common Health Conditions.

What is cerumen? Cerumen impaction?

Cerumen is ear wax. It is a natural part of our body and is important for the health of our ears. The normal body processes typically move the wax out of the canal and along with it dirt and dead skin cells. Ear wax is normal and generally does not need to be removed unless it is causing a problem. Sometimes, however, too much wax builds up causing a blockage of the ear canal. This is called cerumen impaction.

What are the signs and symptoms of cerumen impaction?

A sensation of ear fullness
Hearing loss
Ringing in the ears (tinnitus)
Ear pain
Dizziness
And/or ear drainage or odor

Are there unique symptoms in people with Down syndrome (DS)?

Some people with DS will report the symptoms of cerumen impaction noted above. However, many do not, and it is only discovered when an ear exam is done. Despite the lack of reporting symptoms, the individual may still be having symptoms. It may be noted that a person with DS seems to not be paying attention, is not able to follow directions, or is losing skills. There may also be a behavioral change. These changes may be due to hearing impairment, discomfort, ringing in the ears, or other reasons.

What can cause cerumen impaction?

People with DS are more likely to develop cerumen impaction. This is likely due to ear canals that are often smaller or more curved, making it difficult for the body’s natural processes to remove the wax.

Additional risk factors for developing cerumen impaction include:

Use of hearing aids, earplugs, or earbuds
Having a lot of ear hair
Certain skin conditions like eczema (causing the production of more wax). People with DS tend to have drier skin that may contribute to excess ear production.
Older age
Putting cotton swabs or other objects into the ear canal (putting Q-tips or cotton swabs in the ear can push ear wax in beyond the body's natural capabilities of removing it)

How is it diagnosed?

Your health care provider can examine inside your ear using a medical instrument called an otoscope. He/she can assess for the buildup of wax using the otoscope.

How can cerumen impaction be treated and/or prevented?

At home

**Speak to your health care provider before using at-home treatments for ear wax, especially if you have a hole (perforation) or tube in your eardrum. It is generally recommended to NOT put any liquid in an ear that has a perforation (hole) or a tube in the ear drum.**

A solution called carbamide peroxide can be used to soften the hardened wax and allow it to be easily removed from the outer ear with a cotton swab. Carbamide peroxide can be found in several over-the-counter ear drops (e.g., Debrox).
Put 3-4 drops of baby oil, almond oil, mineral oil, olive oil, or diluted hydrogen peroxide in each ear two times per week. The providers at the Adult Down Syndrome Center typically recommend baby oil over diluted hydrogen peroxide because diluted hydrogen peroxide can be drying (and many people with DS already have a tendency towards dry skin).
There are some over-the-counter devices that can be used to flush the ear canal. Caution is advised to avoid injuring or perforating the ear drum by applying too much pressure.
To help prevent ear wax build-up, cotton swabs can be used on the outside part of the ear to move ear wax outwards from the ear canal but the cotton swabs should not be put into the ear canal.

At the doctor's office

Ear lavage. Health care providers can use a warm water solution or hydrogen peroxide solution to soften the cerumen and flush your ear canals.
Some providers (often an otolaryngologist/ENT physician) have a magnifying device and a suction device that can be used to remove the cerumen in their office.

Tips for making the cleaning process more tolerable

Some individuals with DS find the process of having the wax removed challenging. Some aids to get the wax removed include:

Consider making an appointment only for this procedure so the appointment time is limited and there are not other procedures (such as injections) that may also be challenging.
Consider using relaxation strategies or sensory strategies prior to the procedure.
Consider using a visual story such as this Getting Ear Wax Removed story to prepare for the procedure.
Include the individual in the process. When the ears are being irrigated, asking the person to hold the collection basin and praising his/her efforts can be helpful.
Review that there may be some pressure but it should not hurt.
Discuss the benefits such as improved hearing and relieving the sense of pressure or fullness.
Some individuals want to see the wax after it has been removed. It gives them a better understanding of why it was done. Some individuals definitely do not want to see it, so it is good to ask before showing it to him/her.
Likewise, some family members desire to see the wax. This may help them understand the importance of regular care.

If there is a hole or tube in the eardrum, irrigation should not be done. In addition, some individuals with DS find the irrigation procedure unpleasant. For these individuals, we refer to an ENT physician to have the wax removed. The above techniques can be used for that procedure as well to help the individual allow the procedure to be done.

Infrequently, a person with DS may not be able to allow any of these procedures be done. In these situations, an ENT may opt to take the person to the operating room and remove the wax under sedation/anesthesia. For some individuals, additional procedures that the person finds challenging can also be done while under sedation/anesthesia (e.g., blood drawing, dental work, etc.)