As this section is only concerned with excess wax in the ear, we are only looking at the major features of this condition. Nearly all cases of pain require referral. The sensation must be restricted to the outer ear canal. If pain is experienced behind the ear, which indicates infection, referral is required. Impacted cerumen is usually unilateral, although if over enthusiastic cleaning of the outer ear has been practised, bilateral involvement will occur.
Some patients produce an excessive quantity of cerumen.
Comments such as, 'the patient often requires to have their ears syringed', provide clues to this problem. Excessive wax will also trap water from any source such as swimming, showering and shampooing the hair. Patients reporting an intermittent temporary loss of hearing suggest that the problem is trapped water. Another feature of excess cerumen is that the problem of hearing loss increases with time. Natural history Progressive hearing loss and the feeling of a blocked ear are insidious features and provoking factors may provide valuable clues to the cause of these symptoms.