Hearing loss due to impacted wax can be frustrating and stressful and, if untreated, can contribute to social isolation and depression. Wax in the ear canal can also prevent adequate clinical examination of the ear, delaying assessment and management; for example, audiologists cannot test hearing or prescribe and fit hearing aids and doctors cannot examine the eardrum if the ear canal is blocked with wax.

The main approaches to removing earwax include the use of wax softeners (such as olive oil drops, sodium bicarbonate drops, or water) prior to mechanical removal using electronically controlled irrigation of the ear canal (flushing the wax out using water), or microsuction (using a vacuum to suck the wax out). It is not clear which earwax removal approach is the most effective and in which setting this should take place. Currently there is considerable variation in practice; people are inappropriately given ear drops for weeks without effect, irrigation in primary care may not be available and many are referred to ENT services for wax removal. Using secondary care services for earwax removal has considerable resource implications. There is a need for quick, efficient and cost-effective wax removal. This chapter examines the most effective method and the most appropriate setting for wax removal