OtoRhinoLaryngology Portal

The Leading Online Gallery of Otolaryngology and Head & Neck Surgery Specialty

OtoRhinoLaryngology Portal Video Collections

YouTube and MEDtube



Excessive earwax is a very common condition.  It causes conductive hearing impairment if significantly block the ear passage.  Earwax dissolving solution need to be instilled prior to its removal.  Traditionally, Higginson ear syringe was used to flush warm saline at body temperature.  Present day techniques include earwax suctioning/toilet under microscope view and electric-driven saline irrigation.

A close-up view showing direction of water jet

towards posterosuperior aspect of the ear canal.


Further readings:

1.Subha ST, Raman R. The role impacted caerumen in hearing loss. Ear Nose Throat J. 2006 Oct;85(10):650, 652-3.

2.Lum CL, Jeyanthi S, Prepageran N, Vadivelu J, Raman R. Antibacterial and antifungal properties of human caerumen. J Laryngol Otol. 2009 apr;123(4):375-8. Epub 2008 Aug 11. 

3.Paula McGrath.  Secretion secrets: things you didn't know about earwax @ BBC Health, 16 March 2014

Earwax: Endoscopic View Before & After Syringing

The typical appearance of an adequately     The appearance after syringing done.

soften earwax.  Minor abrasion seen due                      (same patient)

to cotton tip injury used by patient to self

                   clean the ear. 




Endoscopic findings in a patient complaining of right earache few days after syringing done for earwax removal.  The osseous ear meatus appeared inflamed and focal haematoma seen (H). Minor residual soft earwax visible posteriorly (W).  Possible other complications include eardrum perforation and ear canal skin laceration or abrasion, (TM- tympanic membrane)

Earwax Removal Without Prior Softening With Otic Drops



This technique is usually performed for small to moderate amount of earwax impaction in whom who needs quicker relief of ear blockage and hearing loss.  However, near complete occlusion is also feasible to be removed.  Gentle manipulation with cold instruments and suctioning under good microscopic view are required.  If it becomes intolerable and difficulty encountered, the procedure should be deferred to another date.  Adequate earwax softening solution prescribed.  Complications include ear canal  abrasion, laceration, bruise, tympanic membrane injury and secondary infection.




Superficial haematoma complicating removal of hard earwax.  However, this is self-limiting and will resolve completely.

Otoendoscopic Evidence of Self Ear Cleaning Using Cotton Bud or Similar Materials

Earwax smearing onto eardrum surface.    Rippling/wavy epithelial surface of the

                                                             canal secondary to superficial scarring.

Presence on avulsed hair in osseous meatus or on eardrum surface.

Dry earwax flakes in osseous meatus with some sticking onto eardrum surface.



Crumbs or earwax pieces close to eardrum edge. 

 Similar dry flakes in another patient close to the eardrum.

Impacted earwax with bruises of ear canal wall.




Another example of ear canal skin abrasion secondary to self-earwax cleaning using cotton bud or similar instrumentation.

Deeply rolled-over wax layer with partly visible eardrum at the background.

Earwax ball deeply impacted into osseous external auditory meatus.




Probable ear digging injury site with delayed healing ending with exposure of the bone underneath.