Limited good-quality evidence available on earwax removal methods; softeners more effective than no treatment, but evidence for irrigation or mechanical removal is equivocal.

Cerumen impaction is common and saliently affects well-being Cerumen excreted from the skin of the external ear canal provides a protective oily layer, entraps foreign materials and has antibacterial properties. It is produced by special glands and usually is degraded in parallel, so in most people there is no wax accumulation. If a large quantity of wax is retained, it blocks the ear canal and severely interferes with hearing. Such blockage can easily be removed to resume previous hearing. Impaction is caused by ear ‘cleaning’ with Q-tips which often creates a piston mechanism that pushes the wax inside the canal towards the tympanic membrane. This is one of the reasons why regular wax removal or ‘cleaning’ is not recommended. Some populations though tend to develop frequent cerumen impaction, which is refl ected as reversible, profound, hearing loss. Other symptoms include tinnitus, itching, cough, dizziness or pain. Reasons for higher prevalence include drier secretions, metabolic changes and genetics. Some 5% of the general population in the UK suffers from cerumen impaction at any given time. Among the older people, prevalence reaches up to 65%, and it is seen in more than 30% of the people with intellectual disability. Impaction-associated hearing impairment leads to poor communication, physical immobility, social isolation and depression. Improved cognition may follow earwax removal, and use of spray-applied new formula (Clean Ears) was superior to other common cerumenolytics.1 Old people often reconcile to hearing impairment as expected manifestation of ageing. They further tend to refrain from using assistive devices, mainly due to aesthetic considerations and fi nancial restraints. Few residents in care homes for the older people are actually using hearing aids; the same applies to intellectually challenged people.