Blocked ear: is it wax or an infection?

A wax blockage usually makes an ear feel muffled and full without much pain, and you feel well otherwise. An infection is more likely to hurt, sometimes a great deal, and can come with discharge, a high temperature or a general feeling of being unwell. If you have pain together with discharge or a fever, see a pharmacist or GP rather than booking wax removal.

Wax or infection: how the symptoms compare

There are two common kinds of ear infection. An outer ear infection (otitis externa) affects the canal between the opening of the ear and the eardrum, the same place wax collects. A middle ear infection (otitis media) happens behind the eardrum. Each has a slightly different pattern.

The table can only take you so far. A clinician looking in your ear can usually tell straight away, because wax, an inflamed canal and a red, bulging eardrum look very different.

How a wax blockage usually feels

A wax blockage is more of a nuisance than an illness. Hearing on one side goes dull, the ear feels full, and your own voice may sound oddly loud. It often starts overnight or straight after a shower or swim, when water makes old wax swell. There may be some itching or a mild ache, but you won't have a fever, and nothing leaks out of the ear apart from the odd bit of soft wax.

Wax also tends to respond to softening drops, although it can take several days, and hearing may feel slightly worse at first as the wax soaks up the oil. Our guide to the signs of ear wax build-up covers each symptom in more detail.

Signs of an outer ear infection (otitis externa)

This is the infection most easily confused with wax, because it affects the same part of the ear. It is sometimes called swimmer's ear. The NHS says it is caused by something irritating the ear canal, such as eczema, water or wearing earplugs, or by a bacterial or fungal infection.

The canal becomes red, swollen and sore. Typical signs are pain that gets worse when you pull the earlobe or press the small flap in front of the ear, itching, flaky skin, a feeling of pressure, and sometimes a discharge that may smell. Hearing can go muffled if the canal swells enough to close up.

A pharmacist or GP can look in the ear and may give antibiotic, antifungal or steroid ear drops. While it heals, keep the ear dry, don't swim, and don't put anything into it. Wax removal isn't usually done until the infection has settled.

Signs of a middle ear infection

Middle ear infections mostly affect young children, often after a cold or flu. The pain comes from behind the eardrum and can be intense, often with a high temperature. Children may rub or pull at their ear, be irritable or off their food, not react to some sounds or seem to lose their balance.

Sometimes pressure behind the eardrum makes it burst, and fluid or pus runs out. That sounds alarming, and it should be looked at, but a perforated eardrum usually heals on its own within a couple of months.

The NHS says most ear infections clear up within 3 days without treatment, and paracetamol or ibuprofen can help with the pain (children under 16 shouldn't take aspirin). In England, a pharmacist can assess and treat children aged 1 to 17. See a GP if a baby under 12 months may have an ear infection, or if earache hasn't improved after 3 days.

Other reasons an ear can feel blocked

Wax and infection aren't the only possibilities. These are some of the other common causes of a blocked ear:

• A cold or sinus problem. The tube that links the middle ear to the back of the nose gets congested, so the ear feels full and may crackle or pop. It usually clears as the cold does.
• Flying or diving. Pressure changes can leave an ear blocked for a while after you land. See our guide to blocked ears after flying.
• Water trapped after swimming, which usually works its way out on its own. Read about swimming and ear wax.
• Glue ear, where fluid builds up behind the eardrum. It is much more common in children and usually clears within 3 months. Our guide to ear wax in children explains how it differs from wax.
• A perforated eardrum, often after an infection, a loud bang, a blow to the ear or a sudden change in air pressure.
• Sudden hearing loss that isn't caused by anything in the canal. This needs urgent medical attention, so never assume sudden hearing loss is wax.

Blocked ear: deciding what to do next

If you are still not sure what is going on, working through these questions in order will point you to the right place.

1. Any of the warning signs above? Contact NHS 111 or ask for an urgent GP appointment. Don't book wax removal first.
2. Pain, discharge, a high temperature or a swollen, tender ear? See a pharmacist or GP. It may well be an infection that needs drops or other treatment.
3. Muffled and full, but little or no pain and you feel well? It is probably wax. Try softening drops for 3 to 5 days. Our guide on how to use ear drops shows the technique. Skip them if your eardrum may be perforated.
4. Still blocked after 5 days of drops, or you can't hear anything at all in that ear? Have it looked at by a nurse, pharmacist or clinic. Many GP surgeries no longer remove wax; our guide to ear wax removal on the NHS explains the options.
5. Hearing still not right after the wax has gone? See a GP. You may need a hearing test. Our guide to ear wax and hearing loss explains why.

Why wax removal usually waits until an infection settles

An infected ear canal is swollen and tender, so removing wax from it hurts and can irritate the skin further. Ear irrigation isn't used when there is an active infection, a perforated eardrum, grommets or recent ear surgery, because water could make things worse. Most wax removal clinics will ask you to come back once an infection has been treated and settled.

There is one exception worth knowing about. In an ENT (ear, nose and throat) clinic, cleaning debris out of an infected canal under a microscope is sometimes part of the treatment, because it lets ear drops reach the skin. That decision belongs to a GP or specialist, not a routine wax appointment.

When you book any appointment, mention recent ear pain, discharge or treatment for an infection. The clinician will look in your ear before doing anything and will tell you if it isn't the right time. When it is, microsuction is often chosen for an ear that has recently been infected, because it keeps the canal dry. Our guide on what happens at an ear wax removal appointment walks through a typical visit.