Mark A. Lutterbie, MD, Fellow in Family Medicine, University of Virginia, Department of Family Medicine, Charlottesville, VA, USA.
Daniel F. McCarter, MD, Vice-Chair and Associate Professor of Family Medicine, University of Virginia, Department of Family Medicine, Charlottesville, VA, USA.

Cerumen, or earwax, is the product of the sebaceous and ceruminous glands combined with débrided epithelial cells and hair from the external auditory canal. Cerumen is usually extruded by a combination of jaw movements from chewing and speech, and natural epithelial migration. However, cerumen may become impacted, especially among older adults and individuals with mental retardation. Cerumen impaction may cause hearing loss, otitis externa, vertigo, tinnitus, or cough. There are multiple methods for removing earwax, with limited evidence to support any of the current practices. Irrigation or manual disimpaction using a curette have long been the accepted earwax removal methods, yet neither has been subjected to comparative trials with other methods. Irrigation alone is effective in up to 70% of cases of impacted cerumen. Ceruminolytics or eardrops are effective in up to 40% of cases without irrigation, and when combined with irrigation can be effective up to 97%. Cotton ear buds and ear candling should be avoided.
Key words: cerumen, earwax, irrigation, ceruminolytic, impaction.