Earwax accumulation is one of the most common yet overlooked ear health issues affecting older Australians. While it’s often dismissed as a minor nuisance, impacted cerumen (the clinical term for earwax) can significantly affect hearing, balance, cognition, and overall quality of life.
For older adults who wear hearing aids, the problem is often compounded. Hearing aids can push wax deeper into the ear canal while also becoming blocked themselves, creating a frustrating cycle of reduced hearing aid performance and repeated cleaning or repairs.
Understanding why earwax becomes more problematic with age and knowing which removal methods are safe and effective allows older adults and their families to take a proactive approach to ear health. This article explores age-related changes that increase the risk of earwax, reviews evidence-based removal techniques, and offers practical guidance—particularly for hearing-aid users.
Important note: This article is for general educational purposes only and does not replace individual assessment or medical advice. Always consult a qualified audiologist or GP regarding ear health concerns.
Why Earwax Becomes More Problematic With Age
The relationship between ageing and earwax is complex. Several physiological changes occur over time that make wax build-up and impaction more likely—even in people who have never had ear problems before.
As we age, earwax typically becomes drier and harder. This is partly due to reduced activity of the ceruminous glands and changes in the lipid (fat) composition of the wax. Softer wax tends to migrate out of the ear canal naturally; drier wax does not. Instead, it is more likely to accumulate deeper in the canal, closer to the eardrum.
The structure of the ear canal also changes. The skin lining the canal becomes thinner and more fragile, and many people, particularly men, develop coarser hair growth within the canal. These hairs can trap wax and block its natural outward movement, increasing the risk of impaction.
Another critical factor is the slowing of the ear’s natural self-cleaning mechanism. Usually, skin cells migrate slowly from the eardrum towards the outer ear, carrying wax with them. With age, this epithelial migration becomes less efficient, allowing wax to compact and harden before it can escape.
Finally, medications and medical conditions common in later life can contribute. Some diuretics, antihistamines, and other drugs can dry out earwax. Skin conditions such as eczema or psoriasis, as well as previous ear surgery, can also interfere with normal wax production and movement.
Hearing Aids and Earwax: A Two-Way Problem
For the many Australians over 65 who wear hearing aids, earwax presents a particular challenge; the relationship between hearing aids and wax works in both directions.
Hearing aids sit in or across the ear canal, physically blocking the natural outward movement of wax. At the same time, the device can stimulate the ear to produce more wax as a protective response. Increased production combined with reduced clearance creates ideal conditions for impaction.
Earwax is also the most common cause of hearing-aid malfunctions. Even small amounts of wax can block the device’s receiver (speaker), leading to sudden drops in volume or clarity. Regular wax management has been shown to extend the lifespan of hearing aids and reduce repair costs—an important consideration given the investment involved.
For many hearing aid users, it can be difficult to tell whether reduced hearing is due to worsening hearing loss, a blocked device, or wax in the ear itself. This is why regular audiological review—rather than device troubleshooting alone—is essential.
Evidence-Based Earwax Removal: What Actually Works
When removing impacted earwax in older adults, safety is paramount. The skin of the ear canal is more delicate, and there is a higher risk of conditions such as eardrum perforations or prior surgery.
Microsuction
Microsuction is widely regarded as the gold standard for earwax removal, particularly for older adults and hearing aid users. It uses a fine suction tip under direct visualisation (with a microscope or video otoscope) to gently remove wax without introducing water into the ear.
For seniors, the advantages are significant: immediate results, high precision, and suitability for people with perforated eardrums, mastoid cavities, or a history of ear surgery. Research consistently shows lower complication rates compared with irrigation when performed by trained clinicians. The procedure is also quick, which can be reassuring for people with cognitive or anxiety-related concerns.
Irrigation (Syringing)
Ear irrigation uses water to flush out wax and was once routine. However, current evidence supports a more cautious approach, especially in older adults. Risks include eardrum perforation, ear infections, and dizziness caused by vestibular stimulation—particularly concerning in those already at increased risk of falls.
For this reason, many Australian audiology clinics now prefer microsuction. If irrigation is used, it should be done only after confirming the eardrum is intact and is generally avoided in higher-risk patients.
Manual Curette Removal
This method involves removing wax using small instruments under direct vision. While effective in specific cases, it requires significant skill and carries a higher risk of canal abrasion or bleeding in older ears with fragile skin. It is usually reserved for situations where suction is not appropriate.
At-Home Treatments
Over-the-counter wax-softening drops may help soften wax before professional removal, but they rarely resolve established impaction on their own. Importantly, drops should only be used when the eardrum is known to be intact—something that requires professional assessment.
Ear candling has been thoroughly debunked and can cause burns, blockages, and ear damage. It should be avoided entirely.
A Practical Earwax Maintenance Schedule for Seniors
Prevention is always preferable to treating a complete impaction. A simple, individualised routine can significantly reduce problems.
For hearing aid users:
Clean hearing aid receivers daily using the supplied brush
Check devices regularly for wax blockages
Schedule professional ear checks every 3–6 months, ideally alongside hearing aid reviews
Never insert cotton buds or other objects into the ear canal
Report sudden changes in hearing or device performance promptly
For older adults with a history of wax build-up (without hearing aids):
Annual ear checks with an audiologist or GP
Use wax-softening drops only if previously recommended
Be alert to symptoms such as hearing reduction, fullness, tinnitus, or dizziness
Seek immediate assessment if there is:
Sudden hearing loss
Ear pain, discharge, or bleeding
Persistent dizziness or balance issues
A blocked sensation that does not improve after a few days of drops
Supporting Ear Health: Guidance for Families and Carers
For caregivers, ear health can be easy to overlook—but it matters. Untreated hearing issues are linked to social withdrawal, cognitive strain, and increased fall risk.
Wax build-up may present subtly. An older person might not complain of ear fullness but may increase the TV volume, ask for repetition, or withdraw from conversations. These changes are often mistaken for ageing or cognitive decline when the cause is actually treatable.
Building ear care into daily routines—such as hearing aid cleaning—can help. Keeping track of ear check appointments and ensuring they are attended is equally essential. Resistance to hearing aid use may reflect discomfort caused by wax rather than reluctance to wear the device.
Accessing Safe, Professional Earwax Removal
Access to high-quality earwax removal has improved significantly across Australia. Many independent audiology clinics now offer microsuction and video otoscopy, allowing patients and caregivers to see precisely what is happening inside the ear.
When choosing a provider, look for qualified audiologists or ENT specialists with specific training in cerumen management. Ask about the techniques they use and their experience with older adults and hearing aid users. Independent clinics offer the added benefit of focusing solely on hearing health rather than product sales.
At The Audiology Place, we use microsuction as our primary removal method and integrate wax management into comprehensive hearing care. For hearing aid users, we coordinate wax removal with a full hearing assessment and real-ear measurement to ensure devices perform optimally once the ear canal is clear.
Earwax and the Bigger Picture of Hearing Health
Earwax management is only one part of maintaining good hearing health. Once wax is removed, any underlying hearing loss becomes clearer—allowing appropriate intervention.
Comprehensive care may include hearing tests, speech-in-noise assessment, middle-ear testing, and verification of hearing aid performance using real-ear measurement. Follow-up after wax removal ensures symptoms have resolved and helps establish a personalised prevention plan.
