Ear Health for Older Adults

Why Earwax Problems Increase with Age

Several age-related changes converge to make earwax impaction more common in older adults. Ceruminous gland activity decreases with age, producing drier, harder wax that migrates less easily. The jaw movements that assist wax migration — chewing, talking — become less vigorous. The skin of the ear canal becomes thinner and less elastic, slowing epithelial migration. And hair growth in the ear canal, more common in older men, traps wax and impedes its outward movement.

Research published in the Journal of the American Geriatrics Society found that cerumen impaction affects approximately one third of older adults in care settings, and that it is significantly underdiagnosed. A study by Raman et al. found that routine ear examination in nursing home residents identified impaction in 35% of residents — most of whom had not reported ear symptoms.

Hearing aid use, which is more prevalent in older adults, compounds the problem. The device physically blocks wax migration, causing accumulation around the device. Hearing aid wearers are significantly more likely to experience impaction than non-wearers, and impaction is a leading cause of hearing aid malfunction.

The Wider Impact on Health and Wellbeing

Untreated earwax impaction in older adults has consequences that extend well beyond hearing. The most significant is the contribution to social isolation. Hearing loss makes conversation effortful and exhausting — people withdraw from social situations, stop attending events, and reduce their interactions with family and friends. The cumulative effect on mental health and cognitive function is substantial.

There is a well-established association between untreated hearing loss and cognitive decline. A landmark study by Lin et al. in the Archives of Neurology found that mild hearing loss doubles the risk of dementia, moderate loss triples it, and severe loss increases it fivefold. While the relationship is complex and not fully understood, the clinical consensus is that treating hearing loss — including addressing wax impaction — is an important component of dementia prevention.

Balance is another concern. The ear plays a central role in vestibular function, and wax pressing against the eardrum can affect balance and increase fall risk. Falls are a leading cause of injury and hospitalisation in older adults — a connection that makes ear health checks in this population clinically significant.

For carers and family members: what can appear to be confusion, cognitive decline, or withdrawal in an older person is sometimes simply untreated hearing loss caused by wax impaction. A straightforward ear check — and removal if needed — can produce a striking improvement in engagement and communication.

Assessment and Treatment Considerations for Older Adults

The same removal methods used for younger patients — microsuction and ear irrigation — are appropriate for older adults, with some considerations. Microsuction is generally preferred in older patients because it doesn't involve water and is less likely to cause dizziness. Older adults are more prone to benign paroxysmal positional vertigo (BPPV), and irrigation can occasionally trigger this in susceptible individuals.

Wax in older adults is often harder and drier, which means softening with olive oil drops before the appointment is particularly important. We recommend using drops for at least five days before a removal appointment — this makes the procedure faster, more comfortable, and more effective.

For older adults who find it difficult to travel, we offer home visits across Devon. We bring the same equipment and provide the same standard of care as a clinic appointment — in the comfort of the patient's own home.

Preventive Ear Care for Older Adults

Given the higher risk of impaction in older adults, a preventive approach is more effective than waiting for symptoms to develop. Regular use of olive oil drops — two to three times per week — keeps wax soft and easier to migrate. Routine professional removal every three to six months prevents accumulation before it becomes symptomatic.

Annual ear health checks are a sensible addition to routine health monitoring in older adults, particularly for those with hearing aids, a history of impaction, or cognitive concerns. An ear health assessment takes under 30 minutes and provides a clear picture of ear canal health, wax status, and any other findings that warrant follow-up.

For more on day-to-day ear care, our practical guide covers the steps that make the most difference — including how to use olive oil drops correctly and how to protect the ears from water.