Bilateral impacted cerumen means earwax has built up and hardened in both ear canals to the point where it’s blocking them. “Cerumen” is the medical term for earwax, “impacted” means it’s packed tightly enough to cause problems, and “bilateral” simply means both ears are affected. It’s a common condition, occurring in roughly 19% of the general population and about 30% of older adults.
Why Earwax Gets Impacted in Both Ears
Your ear canals are designed to be self-cleaning. Tiny hairs slowly push old wax outward, where it dries up and falls out on its own. Impaction happens when something disrupts that process, and because the disruption usually affects both ears equally, bilateral impaction is common.
The most frequent culprit is putting things in your ears. Cotton swabs don’t actually remove wax. They push it deeper, and the physical contact stimulates the tiny hairs inside the canal to signal the glands to produce even more wax. Hearing aids, earplugs, and earbuds create the same problem: they act as physical barriers that block the natural outward migration of wax while also stimulating extra production. Since most people use these devices in both ears, both sides get impacted at the same rate.
Anatomy plays a role too. People with narrower or more curved ear canals, or those with more hair growth inside the canal, are more prone to buildup. Older adults are especially vulnerable because earwax tends to become drier and harder with age, making it less likely to work its way out naturally.
Symptoms to Recognize
When only one ear is blocked, you might not notice much. But when both ears are impacted, the symptoms are harder to ignore. The most common ones include:
- Hearing loss: a muffled or “underwater” quality to sounds, often the first thing people notice
- Fullness or pressure: a plugged feeling in both ears
- Tinnitus: ringing, buzzing, or humming sounds
- Ear pain: dull aching or sharper discomfort, especially when chewing or lying down
- Itching inside the ear canal
- Cough: a reflex cough triggered by the vagus nerve running through the ear canal
- Dizziness: rare, but some people experience a mild sense of imbalance
Because bilateral impaction reduces hearing in both ears simultaneously, it can be mistaken for age-related hearing loss, especially in older adults. This is one reason roughly 30% of older adults need cerumen management. Removing the wax often reveals that the underlying hearing is much better than it seemed.
How It’s Diagnosed
A healthcare provider diagnoses impacted cerumen by looking into the ear canal with an otoscope. If the wax is dense enough to block the view of the eardrum, it’s considered impacted. When both sides are blocked, the diagnosis is bilateral impacted cerumen, classified under the diagnostic code H61.23. Treatment is recommended whenever the blockage causes symptoms or prevents the provider from examining the eardrum properly.
Professional Removal Methods
There are three main approaches a provider may use, and the choice depends on how hard the wax is and your medical history.
Irrigation is the most common method. Warm water or saline (kept at body temperature to avoid dizziness) is gently flushed into the ear canal using a syringe. The water flows around the wax plug and pushes it out from behind. It works well for moderately firm wax and is usually quick, though it can feel strange as the warm water fills the canal.
Manual removal uses small instruments like loops, hooks, or tiny forceps inserted through an otoscope. The provider works under direct vision to scoop or pull the wax out. This method is preferred for very hard, firmly packed wax and is the safest option for people who can’t have irrigation.
Microsuction uses a small vacuum tip to gently suction wax out of the canal. It works best on soft wax or small remaining fragments after other methods have loosened the bulk of the blockage. It’s less effective against a large, hard plug on its own.
Irrigation is not safe for everyone. If you have a hole in your eardrum, ear tubes, or a history of ear surgery, water entering the middle ear can cause infection or damage. In those cases, manual removal or microsuction is used instead.
What You Can Try at Home
If your symptoms are mild, over-the-counter earwax softening drops can help. These products typically contain ingredients that break down or soften the wax so it can drain out naturally. You tilt your head, place a few drops into the ear canal, wait the recommended time, then let the liquid drain out. Most people repeat this for several days.
A few things to keep in mind with home treatment. Don’t exceed the recommended exposure time or frequency listed on the product. Stop using drops if you develop pain, increased pressure, or drainage from the ear. And never attempt home irrigation with a syringe or water pick, as the pressure is difficult to control and can injure the eardrum.
Ear candling, which involves placing a hollow cone-shaped candle in the ear canal and lighting it, has no evidence supporting its effectiveness. It has been linked to burns and further blockage, and the American Academy of Family Physicians specifically recommends against it.
What Happens if It’s Left Untreated
Impacted wax that stays in place can trap moisture and bacteria against the skin of the ear canal, potentially leading to an outer ear infection (otitis externa). The ongoing hearing reduction from bilateral impaction can also contribute to social withdrawal and cognitive strain in older adults, since the brain has to work harder to process muffled sound. The hearing loss itself is almost always fully reversible once the wax is removed, but the longer it sits, the harder and more firmly packed it becomes, making eventual removal more uncomfortable.
Preventing Recurrence
Some people are simply prone to wax buildup and will need periodic professional cleanings. If you’ve had bilateral impaction before, the most effective prevention strategy is to stop putting anything into your ear canals. That means no cotton swabs, no bobby pins, no rolled tissue. Let your ears self-clean.
If you wear hearing aids or use earplugs regularly, periodic checkups to monitor wax buildup are worthwhile, since these devices will continue to promote accumulation. Some providers recommend occasional use of a softening drop (a few drops of mineral oil or a commercial product) every few weeks to keep wax from hardening, though this should be tailored to your situation. Keeping the outer ear clean with a damp cloth after showering is all the routine maintenance most people need.