The ear canal may be blocked by earwax (cerumen), scar tissue, a foreign object, or an insect. Blockages can occur when people, particularly children, put foreign objects, such as beads, erasers, and beans, into the ear canal.
Ear blockages may cause
Symptoms of excessive earwax can range from itching to ear fullness to a loss of hearing. However, even large amounts of earwax often cause no symptoms.
Foreign objects may remain unnoticed until they cause pain, itching, infection, or a foul-smelling, pus-filled discharge.
Before and after attempting to remove earwax, a foreign object, or an insect, doctors may do a hearing test, particularly if the person also complains of hearing loss. If the person's hearing does not return after the blockage is removed, the blockage (or prior attempts to remove it) may have damaged the middle or inner ear. If the person's hearing worsens after the blockage is removed, the removal process may have caused damage. Permanent injury to the ear canal or eardrum, pain, and hearing loss are rare if earwax or foreign objects are removed in a careful and safe manner with proper lighting and instruments.
To remove earwax, the doctor may use an earwax curette, an instrument with a loop at the end, or a suction device. These methods are quicker, safer, and more comfortable for a person than the use of water (irrigation). Irrigation is sometimes done and may be combined with an agent to soften the ear wax. Irrigation is definitely not used if a person has or has had a perforated eardrum (hole in the eardrum) because water can enter the middle ear (air containing space on the other side of the eardrum) and cause a middle ear infection. Similarly, irrigation is not used if there is any discharge from the ear, because the discharge may be coming from a perforated eardrum. Discharge from the ear is most safely removed with a small suction device and a microscope. Irrigation is also not used in people with diabetes mellitus, any disorder that weakens a person's immune system, prior radiation therapy to the head and neck, certain ear canal abnormalities, and people on blood thinning drugs.
Certain solvents (such as hydrogen peroxide, glycerin, or mineral oil) help soften earwax before the doctor attempts to remove it. These solvents cannot be used long-term, however, because they may cause skin irritation or allergic reactions in the ear canal. People should not attempt to remove earwax at home with cotton swabs, bobby pins, pencils, ear candles, or any other items. Such attempts usually just pack the earwax deeper into the canal and can damage the eardrum. Some people require routine cleaning by a doctor because their ear canal is narrow, their earwax is sticky or thick, or they have a chronic skin condition in the ear canal.
Foreign objects in the ear canal should be removed by an otolaryngologist (an ear, nose, and throat doctor). The otolaryngologist carefully removes the foreign body using a microscope and special tools. For many children, removal of a foreign body is usually safest when done in an operating room. In an operating room, children can be sedated or given anesthesia to help them remain still, which prevents additional injury to the ear.
To remove foreign objects, the doctor often uses a small, blunt hook or small vacuum device. Objects with an edge (such as paper) can be removed with small alligator forceps. Objects that are deep in the canal are more difficult to remove because of the risk of injury to the eardrum. A general anesthetic or deep sedation may be needed when a child cannot remain still or when removal is particularly difficult. Often, the doctor needs to use a special microscope to see and safely remove the foreign object.
Insects, particularly cockroaches, may also block the ear canal. To kill the insect, the doctor fills the ear canal with mineral oil or thickened lidocaine (a numbing agent) that provides immediate pain relief. After several minutes, the insect dies, enabling the doctor to remove it.