A plain-English look at what the NHS and NICE advise about cotton buds, what to do if your ear feels blocked, and when to get your ears looked at.
Yes. The NHS advises against using cotton buds in your ears, because they can push wax further in and make a blockage worse[1]. NICE guidance tells clinicians to say the same, and adds that it can damage the ear canal and eardrum[2]. This page explains what can go wrong, what to do if your ear feels blocked, and when it is worth having your ears looked at.
Why cotton buds are a problem
Earwax is not dirt. It is a normal substance that cleans, lubricates and protects the lining of the ear canal, trapping dust and dirt and repelling water[3]. Usually it leaves the canal by itself, helped by natural movements of the jaw[3]. The NHS says earwax normally falls out on its own[1].
A cotton bud gets in the way of that. NICE lists cotton bud use as a risk factor for wax being pushed deeper into the canal[3], and the NHS says that using cotton buds to remove wax "will push it in and make it worse"[1].
The risk is not only a blockage. NICE guidance tells clinicians to advise adults not to clean their ears by putting small objects such as cotton buds into the ear canal, and to explain that this could damage the ear canal and eardrum and push the wax further down[2]. NICE's clinical summary adds that it could perforate the eardrum[3]. The NHS lists hearing loss, earache or a blocked feeling, ringing or buzzing in the ears (tinnitus) and dizziness as symptoms of earwax build-up[1]. A perforated eardrum can also cause hearing loss, earache and tinnitus, and blood, clear fluid or pus can leak from the ear[5].
Most people do not need to do anything to their ears at all. In most cases, earwax does not need to be removed[3].
Is it OK to clean the outside of my ear?
The advice above is about the ear canal, the passage that leads to the eardrum[2]. The visible folds of the outer ear are a different matter. Wiping them with a damp cloth when you wash is not what the guidance warns against.
You do not need to go inside the ear to keep it clean. If you notice wax at the opening of the ear, it is for a clinician or pharmacist to advise on, not for a bud, fingernail or other tool[1][7].
A blocked ear: what the NHS suggests
If your ear feels blocked, the first thing to know is that earwax usually falls out on its own[1]. If it does not and your ear is blocked, the NHS says you can try to soften it yourself[1]:
- Lie on your side with the affected ear facing up.
- Put 2 to 3 drops of olive or almond oil in the ear. Do not use almond oil if you are allergic to almonds.
- Stay on your side for 5 to 10 minutes afterwards.
- Repeat 3 to 4 times a day, for 3 to 5 days.
Over about two weeks, the NHS says lumps of earwax should fall out and your symptoms should improve[1]. NICE's clinical summary also describes ear drops for 3 to 5 days as the first step[3]. A pharmacist can give advice and suggest medicines that dissolve wax[1].
Do not use drops if you have a hole in your eardrum (a perforated eardrum)[1]. The NHS also says not to put eardrops in a perforated eardrum unless a doctor recommends them[5]. If you have had ear surgery or ear problems before, ask your pharmacist or GP before using drops[4].
See a nurse at your GP surgery if your symptoms have not cleared after 5 days, or if your ear is badly blocked and you cannot hear anything[1]. Not all GP surgeries remove earwax. Where they do, the NHS lists electronic ear irrigation, microsuction (suction under direct view) or scraping the wax out with a very small device, and says these treatments are usually painless[1]. If your surgery does not offer it, you may be referred to another NHS service or you may pay for private removal[1].
NICE says earwax removal should be offered to adults in primary care or community ear care services if the wax is contributing to hearing loss or other symptoms[2]. NICE also says not to offer adults manual syringing[2], and that electronic irrigation, microsuction or manual removal with a probe can be considered when the practitioner is trained in the method and has the right equipment[2]. The British Society of Audiology (BSA) practice guidance covers manual removal with simple instruments, electronic irrigation and suction[4].
At Hearology we remove wax by microsuction, with no water in the ear. If you want to know how it compares with other methods, read microsuction versus ear syringing or what microsuction involves.
What not to put in your ears
- Cotton buds and fingers. The NHS says not to use your fingers or any objects like cotton buds to remove earwax[1]. It repeats this for hearing loss: do not put your fingers or any objects like cotton buds in your ears, even if you think they might be blocked[7]. Hairpins, keys, pen tops and fingernails are objects too.
- Ear candles. The NHS says there is no evidence that ear candles get rid of earwax[1]. NICE's clinical summary says ear candles have no benefit for earwax and may cause serious injury[3]. BSA guidance says Hopi candles do not remove wax and strongly discourages them[4].
- Ear vacuums. The NHS says there is no evidence that ear vacuums get rid of earwax[1].
- Water-jet or bulb syringes at home. NICE does not recommend bulb syringing or other self-irrigation, because there is too little evidence about its safety[3]. BSA guidance also advises against self-irrigation[4].
- Anything at all, if you have a perforated eardrum. The NHS says not to put anything inside the ear, such as cotton buds or eardrops, unless a doctor recommends it[5].
What about cotton wool in the ear?
Many people search for "cotton wool in ear" and mean something different from a bud: a plug for earache, a habit, or a way to keep water out.
None of the NHS or NICE pages we read recommends putting cotton wool in the ear to treat a blocked ear or earache. For earache, the NHS suggests painkillers such as paracetamol or ibuprofen, and says to see a GP if earache has not improved after 3 days[6].
There are two cases where the NHS does mention cotton wool, and in both it stays on the outside. For an ear infection, it says to remove any discharge by wiping the ear with cotton wool[6]. For a perforated eardrum, it says to place a large piece of cotton wool covered in petroleum jelly in the outer ear when you wash your hair, to keep water out[5].
If the tip of a bud or a piece of cotton wool is stuck in your ear, do not try to fish it out. NICE's clinical summary lists a foreign body in the ear canal as a reason to refer someone to an ear, nose and throat (ENT) specialist[3].
When to see a clinician
Get advice promptly, through an urgent GP appointment or NHS 111, if you have[5][7]:
- sudden hearing loss in one or both ears
- hearing that has been getting worse over the last few days or weeks
- hearing loss with other symptoms, such as earache or discharge from the ear
The NHS says it might not be anything serious but it is best to get help, as it may need to be treated quickly[7].
See a GP if:
- earache has not got better after 3 days[6]
- you have symptoms of earwax build-up that have not cleared after 5 days, or your ear is badly blocked and you cannot hear anything[1]
- you have had treatment for earwax build-up and your hearing has not come back[7]
Return to a clinician if you develop a fever, ear pain, significant itching, discharge from the ear or swelling at the opening of the ear canal, as these can point to an infection[3]. If you have a high temperature, swelling around the ear, fluid coming out of the ear or a change in your hearing, the NHS lists these among reasons to ask for an urgent GP appointment or call NHS 111[6].
If you would like a clinician to look at your ears and remove wax if it is needed, you can book an ear wax appointment. There is same-day availability, and you can see our clinics. For children aged 3 to 17 we have children's appointments, booked by a parent or guardian. For a child under 12 months, the NHS says to see a GP if you think they have an ear infection[6].
Common questions
Are cotton buds bad for your ears, and should you use them?
The NHS and NICE both advise against using cotton buds in your ears[1][2]. Putting one in the canal can push wax deeper and cause a blockage, and could damage the canal or eardrum[2][3]. Earwax usually leaves the ear on its own[1].
Can cotton buds cause hearing loss?
They can, in two ways. A wax plug pushed into the canal can block the ear and reduce hearing[1][3]. A cotton bud could also perforate the eardrum[3], and hearing loss is one of the symptoms of a perforated eardrum[5]. The NHS says a perforated eardrum usually gets better on its own within 2 months and hearing returns to normal, but you should see a GP if symptoms have not started to improve after a few weeks[5].
What can I use instead of cotton buds?
Usually nothing, because most ears need no cleaning[3]. If your ear feels blocked, the NHS suggests 2 to 3 drops of olive or almond oil, three to four times a day for three to five days, or speaking to a pharmacist[1]. If that does not work, a clinician can remove the wax (see "A blocked ear" above).
Is it OK to clean the outer ear?
The warnings are about the ear canal[2]. Wiping the visible folds with a damp cloth when you wash is fine; the warnings are about the canal. Do not put anything inside the canal[1].
What if my ear feels blocked after I used a cotton bud?
Do not use another bud or any object to try to clear it[1][7]. If you do not have a perforated eardrum, you can try the oil drops described above[1]. See a nurse at your GP surgery if it has not cleared after 5 days, and ask for urgent advice if you have sudden hearing loss, worsening hearing, earache or discharge[1][5].
Is cotton wool in the ear better than a cotton bud?
Neither is a treatment for a blocked ear or earache[1][6]. The NHS mentions cotton wool only for wiping discharge from the outer ear in an ear infection and, with petroleum jelly, to keep water out of the outer ear if you have a perforated eardrum[5][6].
