Definition and Overview

Cerumen refers to the earwax that builds up inside the ears. This is a common problem among children because of the small size of their ears, making it hard for dirt to get out the natural way.

Earwax is actually necessary for the ear’s health. Produced by special glands located in the outer third of the ear canal, it is responsible for protecting the sensitive skin lining of the ear canal and killing germs that get into the ear. The ear canal, however, is designed to clean itself; as the old skin lining moves out of the ear, the earwax falls out along with it. However, there are cases wherein the glands produce more earwax than normal, causing a buildup, or old dry earwax does not fall out like it should, causing an accumulation and possibly a blockage.

In such cases, the problem can easily be treated with eardrops that are available from the pharmacy. These work by softening the earwax, allowing it to fall out naturally. However, eardrops can sometimes cause skin irritation and are not suitable for use in some cases. Thus, a doctor may elect to perform paediatric cerumen removal.

Who Should Undergo and Expected Results

Paediatric cerumen removal becomes necessary when (1) a child’s ears are blocked due to the presence of excessive earwax and (2) when eardrops do not seem to help.

Thus, earwax removal procedures may be beneficial for:

  • Children who naturally produce more than the normal amount of earwax
  • Children who produce unnaturally hard or dry earwax
  • Children with especially narrow ear canals
  • Children with hairy ear canals
  • Children with bony growths in the ear canal’s structure
  • Children who frequently insert objects into the ear, such as ear plugs or cotton buds
  • Children who wear hearing aids
  • Children with ear tubes or myringotomy
  • Children with perforated ear drums (and thus cannot use eardrops)


Although earwax can easily become dislodged as a child’s ears get bigger, it is possible that ear blockage can cause some complications, thus requiring medical intervention.

The symptoms or complications that may arise due to ear blockage caused by cerumen include:

  • Earache or otalgia
  • Hearing loss
  • Itchiness
  • Infection
  • Tinnitus or hearing sounds from inside the body
  • Vertigo
  • Otorrhea, or drainage or discharge from the ear
  • Bad odor from the ear
  • Cough


If a child has earwax build-up but does not meet the above criteria and does not experience the above symptoms, the doctor may advise the parent or guardian to wait until the child is a little older or when his or her ear canal is wider. At this point, the problem may resolve on its own or performing cerumen removal procedure will be safer for the child.

At the end of the treatment, the child’s earwax will be removed, his ears cleaned and any related symptoms will be relieved.

How the Procedure Works

Paediatric cerumen removal is performed by a pediatric ENT specialist, a doctor specializing in conditions affecting the ears, nose, and throat of children. Parents may visit an ENT in their area or ask for a referral from their primary care provider or their child’s pediatrician.

During the appointment, the doctor first examines the inside of the child’s ears to determine the degree of blockage. He may also conduct some basic hearing tests if the child is complaining of some symptoms.

The first course of treatment is the prescription of eardrops. The doctor will ask the parent or guardian to try using eardrops first before resorting to other treatment methods.

If eardrops do not work, other available cerumen removal procedures will be recommended. These include:

  • Manual cerumen removal – The paediatrician or ENT specialist can manually remove earwax using a plastic or metal instrument. However, the size of the child’s ear may be a problem.

  • Ear irrigation – This is a painless procedure that removes earwax easily and in a short amount of time. It is performed by using an electric pump to push water into the ear to wash out any debris and blockage.

  • Microsuction – This procedure works by sucking the earwax out of the ear using a small device.

  • Aural toilet – This procedure works by scraping out the earwax using a small instrument with a hoop in the end.

Possible Risks and Complications

Parents are advised to refrain from trying to dislodge or remove earwax on their own as there are some risks involved in cleaning a child’s ears. In fact, one of the most common causes of earwax impaction among children is the incorrect attempt to remove earwax. This is because using a cotton bud or other objects can push the earwax further into the ear and damage the child’s ear.

Also, not all cerumen removal procedures may be safe for paediatric patients. While they can be performed on adolescents and teenagers, young children are usually only given eardrops due to the small size of their ears, which make other procedures risky, unless they are experiencing severe symptoms.

Moreover, some procedures may not be safe for children who have existing medical conditions. For example, manual earwax removal, even by a doctor, is not safe for children with bleeding disorders, while ear irrigation is not safe for children suffering from immune system disorders and diabetes.

There is also a risk of recurrence, in which the child continues to get earwax buildups even after a cerumen removal procedure. One way to avoid cerumen buildup and ear problems is to clean the external ear area regularly with a damp washcloth wrapped around the index finger. There is no need to clean the ear canal itself. Regularly using eardrops, if it is safe for the child to do so, may also help maintain long-term ear cleanliness.

References:

  • Armstrong C. Diagnosis and management cerumen impaction. Am Fam Physician. 2009;80:1011-1013.

  • House JC, Lee DJ. Topical therapies of external ear disorders. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; 2010:chap 138.

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