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GENERAL PRINCIPLES Cerumen or ear wax is a normal ear canal product composed of epithelial cells, sebaceous and ceruminous gland secretions and hair. The function of cerumen is to clean, lubricate and protect the ear canal.   The usual course of cerumen evacuation is a natural migration process in which the cerumen moves from the tympanic membrane to the external canal aided by jaw movement. Therapeutic options for removing excess cerumen include using: Cerumenolytics are usually made with mineral oil or hydrogen peroxide. It should be noted that cerumenolytic drops were not proven to be superior to water.  Manual removal with an instrument. This technique requires direct visualization, instrumentation and experience to perform and will not be addressed in this procedure. Irrigation with a large syringe or mechanical jet irrigator There is no demonstrated advantage to one method over another. It is suggested the treatment method used should depend on the resources available, the experience of the clinician with the available options, the ease at which the canal can be cleared and shared decision-making. In general, it is not recommended to treat cerumen impaction in patients who are asymptomatic and whose ears can be adequately examined. For patients who are not able to express symptoms (young children and children who are cognitively impaired), the need to intervene should be evaluated. The use of hearing aids or ear plugs can disrupt the normal self-cleaning process of cerumen making these patients more at risk for cerumen impaction.