Earwax

Also called Impacted earwax, Cerumen

Normal, protective, and when it blocks the ear it causes hearing loss that gets mistaken for something far worse.

What it is

Earwax is normal and protective, and the ear cleans itself. Most people never need anything done.

It earns an entry because impacted wax is one of the commonest reversible causes of hearing loss, and because in older people that hearing loss is regularly recorded as confusion, withdrawal or cognitive decline.

Removing wax from an older person's ears has, more than once, been described by families as getting somebody back.

The NHS position on wax removal has shifted, and in many areas it is no longer routinely provided in general practice, which has pushed people towards private services and towards dangerous self-treatment.

Cotton buds push wax deeper and cause most of the impaction they are meant to prevent. Ear candles do not work and cause burns and perforations.

Signs you might notice

Gradual hearing loss in one or both ears.

A feeling of fullness or blockage. Earache.

Tinnitus, or hearing your own voice loudly.

Itchiness, and sometimes dizziness.

In older people or those with dementia: withdrawal from conversation, apparent confusion, or being described as not listening.

Sudden hearing loss is different and needs urgent assessment; do not assume it is wax.

How it can affect day-to-day life

Hearing aid users are the group most affected. Wax builds up more with aid use, blocks the aid, and the person stops wearing it and withdraws.

In care settings, checking the ears should be part of assessing anybody whose engagement has dropped. It rarely is.

Access is a genuine problem. Provision varies enormously by area, and private removal costs money that many people do not have.

Supporting someone well

Check the ears before concluding somebody has cognitive decline or has become withdrawn.

Never use cotton buds, and never use ear candles.

Soften wax with olive oil or sodium bicarbonate drops for several days first. Much of it then clears on its own.

For hearing aid users, make ear checks and aid cleaning a routine named task rather than an assumption.

Ask what wax removal service is available locally: some GP practices, some audiology services, and pharmacies increasingly.

Do not use drops or irrigation if there is a perforated eardrum or ear surgery in the past.

Treat sudden hearing loss as urgent, not as wax.

Where to get help

A pharmacist can advise on softening drops.

Ask the GP practice what wax removal is available locally; provision varies.

Sudden hearing loss in one ear is a medical emergency, treatable within days and often not after.