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Why do I have blocked ears but no ear wax?

It is not uncommon for people to book an appointment for ear wax removal only to be told there is no wax to be removed.

This can be disappointing for those hoping for the issue to be resolved, but the sensation of having full or blocked ears can be caused by more than ear wax.

Woman putting a finger into her ear

The most common potential causes of blocked ears, without wax present include: Otitis Externa (ear infections) Otitis Media with Effusion (fluid build-up in the middle ear, behind the ear drum), and Eustachian tube Dysfunction.


These issues can all create the feeling of blockage or fullness in the ear, and can also be accompanied by ear pain (otalgia), tinnitus and a temporary hearing loss.


Eustachian Tube Dysfunction


This occurs when the Eustachian tube (which connects the middle ear to the back of the nose) fails to perform any of its three functions; allowing mucous to drain from the middle ear into the back of the nose, ensuring pressure on either side of the ear drum is equal, and protecting the middle ear from loud sounds, pathogens and secretions. Symptoms include ear fullness, poor hearing, tinnitus, ear pain, imbalance and autophony (being able to hear internal sound in your body.) Causes include swelling of the tissue surrounding the tube, preventing it from allowing air into the middle ear. Patients unable to ‘pop’ their ears, or who feel like their ears are blocked, are likely to have Eustachian Tube Dysfunction if ear wax build up is ruled out as the cause. ETD is often mild and can resolve after a few days. Actions such as swallowing, yawning or chewing can help to equalize the pressure in the middle ear and resolve symptoms, however in some cases symptoms persist and treatment is required. This includes use of decongestants, antihistamines or nasal corticosteroids (Nasonex.)


Otitis Externa (ear infection)


Also known as swimmer’s ear, otitis externa is the inflammation or infection of the outer ear canal. This is usually caused by a bacterial infection. The risk of ear infections is higher in regular water users (hence the name swimmer’s ear) as wet ear canals are more likely to get infected. Symptoms can include pain in the outer part of the ear, a feeling of pressure or fullness in the ear, temporary hearing loss, discharge, and red or swollen ear canals. Infections are usually diagnosed by a GP and treatment involves medicated ear drops.


Middle Ear Effusion (Otitis Media)


Middle ear infections are usually caused by bacteria or most likely viruses and occur when fluid collects behind the ear drum. They are often accompanied by cold symptoms such as sore throat, runny nose and temperature. They are particularly common amongst children, with symptoms including ear pain, fever and discharge. Infections can be treated at home with paracetamol while bacterial infections may require antibiotics. The fluid usually clears by itself but when it doesn’t, glue ear occurs, causing problems with hearing, pain and pressure in the ear and imbalance.


A more uncommon cause can be:

Sudden Sensorineural Hearing Loss

Sudden Sensorineural Hearing Loss, or sudden deafness, occurs when hearing loss takes place very quickly (over a period of several hours or up to three days) and often only in one ear. Symptoms include a blocked or full feeling in the ear, imbalance, nausea, tinnitus or the distortion of sounds in the affected ear. In many cases the cause remains unknown but can include a viral infection of the cochlea, blood flow abnormalities in the cochlea, autoimmune disorders or metabolic causes. Hearing may recover, and is more likely, if treated within the first two weeks of onset. Treatment includes steroids which works best within the first 3 days. This is a medical emergency and early intervention is paramount. Please book an appointment with your GP and get your hearing tested if you've experienced a sudden hearing loss. 

What happens if there is no ear wax?


At your Clear Ears Perth appointment, our clinicians will take an ear health history and perform otoscopy (examination of your ears) and if no wax is found, they will then give you recommendations on the best way to address your symptoms.

This can include making an appointment with your GP, or seeking a referral to an Ear Nose and Throat specialist.

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