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Wax, and why cotton buds make it worse

Ear wax is not dirt and it is not a sign of poor hygiene. It is made deliberately by glands in the outer third of the canal, it keeps the skin slightly acidic and water-resistant, and it traps dust and debris on its way in. The canal then clears itself: the skin lining it migrates slowly outwards, carrying the wax with it, which is why most ears never need any help at all.

Cotton buds interrupt that process at exactly the wrong point. The bud removes a little wax from the outer canal, which feels productive, while pushing the bulk of it inwards past the narrowest part of the canal, where it compacts against the eardrum and dries hard. People who use buds regularly are the group most likely to end up with an impacted plug, which is an awkward thing to be told when the buds were bought to prevent precisely that.

Wax blockage has a recognisable pattern. The hearing loss is usually gradual, it is often on one side, and it very commonly becomes complete after a shower or a swim, because water swells the wax and closes the last remaining gap in the canal. If your ear blocked suddenly while you were drying your hair, wax is a reasonable first guess. If it blocked while you were sitting still and nothing had touched it, be more suspicious.

Fluid behind the eardrum, which you cannot reach

The middle ear, the small air-filled space behind the eardrum, is meant to be dry and full of air. When it fills with thin fluid instead, the eardrum can no longer vibrate freely and everything sounds muffled and distant. This is otitis media with effusion, known as glue ear when it happens in children, and it produces a blocked feeling that is indistinguishable from wax as far as the person experiencing it is concerned.

Nothing you can put in the ear canal will touch it, because the fluid is on the other side of an intact eardrum. Drops do nothing. Buds do nothing except cause a different problem. It usually follows a cold or a bout of sinus trouble, and in most adults it clears on its own over a few weeks as the eustachian tube starts working again, which is why watchful waiting is often the right answer rather than a weak one.

In children it deserves more attention, because a child with muffled hearing for months does not usually complain of a blocked ear. They turn the television up, mishear instructions, seem inattentive at school, or start speaking louder than the room needs. Glue ear is one of the more common reasons a child is thought to be daydreaming when they are simply not hearing well.

Colds, flights and the eustachian tube

The eustachian tube is a narrow passage running from the middle ear down to the back of the nose, and its job is to let air in and out so the pressure behind the eardrum matches the pressure around you. It is normally shut, and it flicks open briefly when you swallow or yawn. That small click you hear when you swallow on a descending flight is the tube doing its work.

When the lining of the nose is swollen, that tube stops opening properly. A cold will do it, allergic rhinitis will do it, and a stretch of heavy pollution or dust will do it. Air trapped in the middle ear is slowly absorbed, the pressure inside falls, the eardrum is pulled inwards, and the ear feels blocked and slightly uncomfortable. Flying or driving down a hill makes it worse, sometimes sharply, because the outside pressure changes faster than the tube can compensate.

This is the one type of blocked ear where treating the nose is more useful than treating the ear. Managing the allergy, clearing the nasal congestion and, where advised, using a short course of a decongestant or a steroid nasal spray addresses the cause rather than the symptom. Trying to force the ear open by pinching your nose and blowing hard is best done gently, if at all, and not during an active infection.

The one that cannot wait

There is a form of hearing loss that feels exactly like a blocked ear and is not a blockage at all. Sudden sensorineural hearing loss comes from the inner ear or the hearing nerve rather than the canal or the middle ear, and it typically arrives over hours or is noticed on waking — one ear simply muffled, often with ringing, sometimes with a little dizziness, and nothing to see in the canal.

Because it feels like wax, it gets treated like wax. People buy drops, wait a week to see whether it settles, and only come in when it has not. That delay is the problem: treatment works best when it is started within the first few days, and the window is measured in days rather than weeks. Nobody should be left feeling foolish for coming in and being told their ear was only blocked with wax after all, which is the far more likely outcome and takes two minutes to establish.

The rule worth remembering is short. Hearing that drops suddenly in one ear, particularly if nothing touched the ear and particularly if there is ringing with it, should be examined the same day.

What is safe to try at home

If the ear is simply blocked, with no pain, no discharge, no bleeding and no sudden change in hearing, a few days of olive oil or pharmacy softening drops is a reasonable first step. Warm the oil to roughly body temperature before it goes in, since a cold drop against the eardrum can set off a brief spinning sensation. Lie with that ear uppermost for a minute or two afterwards, then sit up and let the excess run out onto a tissue.

Expect it to take days rather than minutes, and expect the ear to feel slightly more blocked at first as the wax swells before it starts to break up. Do not follow the drops with a cotton bud, which undoes the entire point of using them. Ear candling is worth naming specifically because it is still sold as a natural remedy: it removes no wax at all, and it has caused burns, blocked canals and perforated eardrums.

Do not put anything in the ear, drops included, if there is pain, discharge or bleeding, if you know or suspect a perforated eardrum, if you have had ear surgery or have grommets, or if that ear is your only hearing ear. In those situations the ear needs looking at rather than treating.

Having a blocked ear looked at in Hyderabad

An examination settles in a couple of minutes what guesswork cannot settle at all. The canal and eardrum are examined with an oto-endoscope, a slim camera-fitted scope whose view can be shown on a screen, so it is immediately clear whether the canal is full of wax, whether the eardrum is intact, and whether there is fluid sitting behind it. Where wax is the answer, it is removed by micro-suction under direct vision. Where it is not, the examination has already ruled it out and the search moves on.

Dr. G Abhinav Kumar Reddy (MBBS, MS-ENT) sees patients at Abhinav's ENT Care Center in Hastinapuram, Hyderabad, including from Vanasthalipuram, LB Nagar, Kothapet and the surrounding areas. To book, call +91 63021 34527 or use the online booking link on the contact page.

This article is general information about blocked ears and is not a substitute for a personal medical assessment. If your hearing has dropped suddenly, please have the ear examined rather than waiting to see whether it settles.

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