Your ear feels plugged, as if there is water trapped in it that will not drain. Voices sound a little muffled. Maybe your hearing aid has started whistling for no obvious reason, or it suddenly sounds weak even with a fresh charge. Before anyone can say whether this is hearing loss, a hearing aid problem or something simpler, someone needs to actually look inside the ear.
Earwax, known clinically as cerumen, is one of the most common reasons hearing seems to change and one of the most common reasons hearing aids stop performing the way they should. At Hearing Aid Factory Outlet inside Sugarloaf Mills in Lawrenceville, every ear examination starts with video otoscopy: a small camera that shows your ear canal and eardrum on a screen, so Gwen Cantrell, BC-HIS, and you can see exactly what is there. What that view shows determines the next step.
What earwax is, and why it builds up
Earwax is not dirt. It is a normal mixture of gland secretions and shed skin cells that cleans, lubricates and protects the ear canal. The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) describes it as a self-cleaning agent with protective and bactericidal properties.
In most ears, the system maintains itself. The skin lining the ear canal slowly migrates outward, and everyday jaw movement from chewing and talking helps carry old wax toward the opening of the ear, where it dries and falls away. That is why most people never need to think about earwax at all.
Problems start when something interrupts that natural outward movement or when the ear produces more wax than it can clear. Common reasons include:
- Hearing aids, earplugs and earbuds. The AAO-HNS guideline notes that objects in the canal can stimulate the wax glands while also physically blocking wax from migrating out. Hearing aid users are at increased risk for impaction.
- Cotton swabs and other objects. Swabs may remove a little wax from the surface, but they often push the rest deeper, where it packs against the eardrum side of the canal.
- Age. Earwax impaction becomes much more common with age. Studies summarized in the guideline found impacted or excessive wax in between 19% and 65% of adults over 65, with nursing home residents at the higher end.
- Ear canal shape. Narrow, curved or hair-filled canals do not clear wax as easily.
- Individual tendency. Some people simply produce more wax than their ears can move out on their own.
Overall, the guideline estimates that excessive or impacted wax affects about 1 in 20 adults and more than one-third of older adults. It is common, it is usually straightforward to identify, and it is worth identifying before drawing any conclusions about your hearing.
What video otoscopy shows
A traditional otoscope lets the examiner look into the ear through a small magnifying lens. Video otoscopy uses a camera to project that same view onto a monitor. You see what Gwen sees, in real time, and the image makes it much easier to understand what is happening in your own ear rather than just being told about it.
During the examination, Gwen looks at:
- How much wax is present and how much of the ear canal and eardrum it covers
- Where the wax sits, near the opening of the canal or deeper toward the eardrum
- What the wax looks like, soft or hard, light or dark, loose or firmly packed
- Whether the eardrum can be seen clearly enough for accurate hearing testing
- Signs that need a physician’s attention, such as irritation, drainage, swelling or anything unusual about the canal or eardrum
- For hearing aid wearers, whether wax is building up where the receiver or dome sits
The findings decide what happens next. A small amount of wax that leaves the eardrum clearly visible usually does not change anything. A larger amount may affect testing or hearing aid performance and needs to be addressed first. And some findings call for a physician. Whatever the view shows, Gwen explains it to you on the screen before anything else happens.
How much of the canal is covered: degrees of earwax buildup
There is no single universal grading scale for earwax. The AAO-HNS guideline deliberately defines cerumen impaction by its effect rather than by a percentage: wax that causes symptoms or prevents a needed assessment of the ear canal, eardrum or hearing system. In the guideline’s words, the definition “does not require a complete obstruction.” A canal that is only partly blocked can still count as an impaction if it causes symptoms or keeps a hearing test from being accurate.
Researchers and clinicians still find it useful to describe how much of the canal or eardrum is covered. A 2025 randomized trial graded wax by how much of the eardrum view was blocked, and a 2006 study graded it by how much of the ear canal was occluded. Combined with the guideline’s findings on hearing, the picture looks like this:
| How much is covered | What it usually means for hearing | What it can mean for testing and hearing aids |
|---|---|---|
| Minimal Less than about 25% of the eardrum view obscured | Normally no measurable effect. This is the ear’s self-cleaning system at work. | The eardrum is usually visible and testing can proceed. Hearing aid wearers may still notice wax on domes or wax guards. |
| Moderate Roughly 25% to 50% obscured | Hearing is usually not affected by the wax itself. Some people notice fullness or itching. | Part of the eardrum may be hidden. Wax near where a receiver or earmold sits can begin to clog wax guards. |
| Excessive Roughly 50% to 80% of the canal occluded | Often still little or no measurable hearing change, but symptoms such as fullness become more common. | Can interfere with an accurate view of the eardrum, with ear impressions and with hearing aid output and fit. |
| Impacted More than 80% of the canal occluded | According to the AAO-HNS guideline, hearing acuity does not diminish until the canal’s cross-sectional area is reduced by at least 80%. Beyond that point, wax can cause a conductive hearing loss of roughly 5 to 40 dB, depending on how completely the canal is blocked. | Most hearing tests cannot be performed accurately. Hearing aids may sound weak, distorted or whistle, and new ear impressions cannot be taken. |
| Severe or complete impaction Canal fully blocked, eardrum not visible, or wax firmly packed and hardened | Muffled hearing, pressure and fullness are common, and symptoms may come on suddenly when the last gap closes. | Testing and hearing aid fitting cannot continue. Severe impactions require referral to an ENT (ear, nose and throat) physician. |
Percentage bands are drawn from published research grading methods (Kamm et al., 2025, eardrum view; Subha and Raman, 2006, canal occlusion) and the AAO-HNS 2017 clinical practice guideline. They are a way to describe what the examination shows, not a diagnosis.
Two points stand out from the research. First, a surprising amount of wax can sit in the canal without changing hearing at all, which is why partial blockage should not automatically be blamed for hearing difficulty. The guideline itself cautions that partial occlusion “may not be the cause of hearing loss.” Second, once the canal is nearly or completely closed, the effect can be substantial. In one study of impacted ears with more than 80% occlusion, hearing improved by an average of about 21 dB after the wax was cleared. That is the difference between comfortably following a conversation and asking people to repeat themselves.
How earwax affects your hearing
Sound has to travel down the ear canal before it reaches the eardrum, the middle ear and the inner ear. When wax blocks that path, it causes what is called a conductive hearing loss: the inner ear may be perfectly healthy, but less sound reaches it. That is different from sensorineural hearing loss, which involves the inner ear or hearing nerve and is usually permanent.
From the inside, the two can feel remarkably alike. Both can make voices sound muffled, make the television seem too quiet and make you ask people to repeat themselves. Wax buildup can also produce:
- A plugged or full feeling in one or both ears
- Muffled hearing that may change suddenly if wax shifts or finally closes the canal
- Itching or discomfort in the canal
- Ringing or other noises in the ear
- Occasionally a cough or, rarely, a sense of imbalance
Many people have both at once: an underlying sensorineural hearing loss plus a wax buildup that makes it seem worse. That is exactly why looking before testing matters. If wax is part of the picture, it needs to be identified so the hearing test measures your hearing and not the blockage.
This matters especially for older adults. The American Academy of Family Physicians notes that hearing loss from earwax impaction can contribute to reversible cognitive difficulties in older people, and the AAO-HNS guideline reports that clearing impacted wax has been associated with improvements in both hearing and cognitive function. For a family member who seems more confused or withdrawn, a simple look in the ear is a sensible early step. Gwen is a Certified Dementia Practitioner, and families caring for someone with memory loss can read more on our page about hearing aids for seniors with dementia.
How earwax affects hearing tests
An accurate hearing test depends on sound reaching the eardrum the way it should. According to the AAO-HNS guideline, most hearing tests “cannot be performed accurately in the setting of complete or partial impaction.” That list includes standard audiometry, middle-ear (immittance) testing, otoacoustic emissions and Real Ear Measurement during hearing aid fitting.
In practical terms, testing through a significant wax blockage can make hearing look worse than it really is, mask the true pattern of a hearing loss or produce results that do not match how you hear in daily life. That is why video otoscopy comes before every comprehensive hearing evaluation. It protects the accuracy of everything that follows.
Ear impressions are affected in the same way. A custom earmold, custom hearing aid or custom hearing protection is built from a silicone impression of your ear canal. The American Speech-Language-Hearing Association notes that wax that does not completely block the canal can still interfere with procedures such as canal impressions. An impression taken over a wax plug captures the wax, not your ear.
How earwax affects hearing aids
For hearing aid wearers, earwax is a daily reality. The hearing aid sits in the canal, the canal responds by producing wax, and the device itself slows the wax’s natural exit. Wax then finds its way into the one part of the hearing aid that sits closest to it: the receiver, or speaker.
The effects are familiar to most long-time wearers:
- Weak or dead sound. A clogged wax guard or receiver opening can make a perfectly good hearing aid sound faint or silent. Starkey’s own troubleshooting guidance lists a blocked Hear Clear wax guard as a cause of weak or distorted sound.
- Whistling (feedback). When wax blocks the canal, sound from the hearing aid cannot travel cleanly to the eardrum. It bounces off the blockage and back into the microphones, where it is amplified again as a whistle. Starkey, Signia and Phonak all identify earwax in the ear canal as a cause of feedback.
- Distorted or intermittent sound. Partial blockages can make sound crackle, cut in and out or lose clarity.
- Repairs. Signia reports that approximately 60% to 70% of damaged hearing aids sent in for repair are clogged with earwax or degraded by organic material.
- Canal health. The AAO-HNS guideline notes that impaction combined with hearing aid use may alter the normal bacterial environment of the ear canal, which is another reason to keep an eye on buildup.
Every major manufacturer builds in protection. Starkey hearing aids use Hear Clear disposable wax guards along with a Surface NanoShield coating that helps repel wax and moisture. Signia uses model-specific guards such as WG 3.0 NanoCare and CeruSTOP. Phonak uses the CeruShield Disk, and Phonak’s user guide recommends changing the filter every four to eight weeks on a standard receiver, or whenever it looks dirty or the sound seems reduced.
A wax guard protects the hearing aid, but it cannot keep wax from building up in the ear canal itself. That is why the AAO-HNS guideline recommends that clinicians check hearing aid wearers’ ears for wax during health care visits. A quick look with video otoscopy during routine hearing aid cleanings and tune-ups can separate an ear problem from a device problem in seconds, and it often explains a “broken” hearing aid that turns out to be working fine. If your hearing aid is acting up, our hearing aid troubleshooting guide covers the checks worth trying at home first.
Signs your hearing aid problem may actually be earwax
- The hearing aid suddenly sounds weak even though it is fully charged or has a fresh battery
- Whistling starts when it never used to, especially with no change in fit
- Changing the wax guard helps, but only for a few days
- The problem is in one ear only, while the other hearing aid sounds normal
- You see visible wax on the dome, receiver or earmold when you take the hearing aid out
- Your ear feels full or plugged even with the hearing aid removed
What not to do at home
It is tempting to try to fix a plugged ear yourself. The AAO-HNS patient guidance is blunt: do not put “anything smaller than your elbow” in your ear.
- Skip the cotton swabs. They often push wax deeper and pack it against the eardrum side of the canal. Hair pins, keys, toothpicks and similar objects can injure the canal or eardrum.
- Never use ear candles. The guideline states there is no evidence they remove impacted wax, and candling can cause serious damage to the ear canal and eardrum.
- Do not over-clean. Excessive cleaning can irritate the canal, invite infection and actually increase the chance of impaction.
- Be careful with drops and irrigation. These are not appropriate if you have had ear surgery, have ear tubes, may have a hole in your eardrum or get frequent ear infections, unless your ENT has specifically cleared them.
- Do not assume. If your hearing changes, have your ears examined rather than guessing whether the cause is wax.
When earwax becomes a medical issue
Most earwax is simply earwax. But some findings and symptoms need a physician, and it is important to know which ones.
Severe impaction. When video otoscopy shows a severe or complete impaction, such as a canal fully blocked by hard, packed wax or a blockage that hides the eardrum entirely, Gwen refers you to an ENT physician for evaluation and care.
Symptoms that are not typical of earwax. The AAO-HNS guideline advises seeking medical attention for ear pain, drainage or bleeding, noting that these are not symptoms of cerumen impaction and need further evaluation.
Sudden hearing loss. A sudden drop in hearing, especially in one ear, should never be assumed to be earwax. The National Institute on Deafness and Other Communication Disorders advises treating sudden hearing loss as a medical emergency and seeing a doctor immediately.
Health factors that change how wax should be managed. The guideline identifies conditions that call for extra care, including blood-thinning medication, a weakened immune system, diabetes, prior radiation therapy to the head and neck, a narrowed ear canal, bony growths in the canal and a hole or previous damage in the eardrum. If any of these apply to you, tell us at your visit.
Knowing when an ear needs a physician before hearing care can continue is part of responsible hearing care. Learn more about our ENT and medical referral assistance.
Why an exam matters before any hearing decision
A plugged ear, a hearing aid that suddenly sounds weak and a gradual decline in hearing can all look alike from the outside. The only reliable way to tell them apart is to look first and test second. That order protects you from buying hearing aids you may not need, from blaming a hearing aid that is actually working and from missing a problem that belongs with a physician.
Gwen Cantrell is a nationally Board-Certified Hearing Instrument Specialist and Certified Dementia Practitioner caring for patients across Lawrenceville and Gwinnett County. An examination starts with a conversation about what changed and a look at your ear canals on the screen, so you understand what the findings mean before any testing or recommendation. Meet Gwen, or read more about how to tell earwax from hearing loss.
Frequently asked questions
Can earwax really cause hearing loss?
Yes. When wax blocks most or all of the ear canal, it can cause a temporary conductive hearing loss of roughly 5 to 40 dB, according to the AAO-HNS clinical practice guideline. Smaller amounts usually do not affect hearing, because hearing is generally not reduced until at least 80% of the canal is blocked.
How do I know if I have too much earwax?
You cannot reliably tell from symptoms alone. Fullness, muffled hearing and itching can come from wax, but they can also come from hearing loss or other ear conditions. A look with video otoscopy shows exactly how much wax is present and how much of the canal it covers.
What is video otoscopy?
It is an ear examination using a small camera that displays the ear canal and eardrum on a monitor. You can watch the screen during the exam and see the same view Gwen sees, which makes the findings easy to understand.
Why does my hearing aid whistle when I have earwax?
When wax blocks the canal, amplified sound cannot travel cleanly to the eardrum. It reflects off the wax and back toward the hearing aid microphones, where it is amplified again as a whistle. Starkey, Signia and Phonak all list earwax in the canal as a cause of feedback.
Do hearing aids cause more earwax?
They can contribute. The AAO-HNS guideline explains that a hearing aid in the canal can stimulate the wax glands and block wax from migrating out, and it identifies hearing aid users as being at increased risk of impaction. Regular ear checks and changing wax guards as recommended help keep both your ears and your hearing aids working.
Should I use cotton swabs to clean my ears?
No. Cotton swabs often push wax deeper into the canal and can injure the ear. The outer ear can be wiped with a washcloth, but nothing should go inside the canal.
When does earwax need an ENT?
Severe impactions require referral to an ENT physician. Ear pain, drainage, bleeding, sudden hearing loss, a history of eardrum damage or ear surgery, and certain health conditions also call for a physician’s evaluation.
Will earwax affect my hearing test results?
It can. Most hearing tests cannot be performed accurately when wax is partly or completely blocking the canal. That is why the ear canals are examined with video otoscopy before testing begins.
Have your ears examined in Lawrenceville
If your ear feels plugged, your hearing seems muffled or your hearing aid has started acting up, the first step is a look inside the ear. Hearing Aid Factory Outlet is inside Sugarloaf Mills at 5900 Sugarloaf Pkwy #423, in Lawrenceville, open seven days a week and serving patients throughout Gwinnett County and Metro Atlanta. Schedule an appointment or call (404) 786-6416.
Sources: AAO-HNS Clinical Practice Guideline (Update): Earwax (Cerumen Impaction), 2017; American Family Physician, Cerumen Impaction: Diagnosis and Management, 2018; Kamm et al., Laryngoscope Investigative Otolaryngology, 2025; Subha and Raman, Ear, Nose and Throat Journal, 2006; ASHA, External Auditory Canal Examination and Cerumen Management; NIDCD, Sudden Deafness; Signia, Does earwax damage hearing aids?; Starkey, Feedback in hearing aids; Phonak, CeruShield Disk.