OBJECTIVES: To examine the literature on impacted cerumen with specific reference to pharmacological ceruminolytic agents, its epidemiology and current management in primary care. METHODS: A systematic literature review was undertaken by an electronic search of the Medline, Embase, Health Star, Current Contents, NHSEED and Cochrane databases. The search terms for the database included ‘cerumen’, ‘ear wax’ and ‘hearing loss’ and included papers published between January 1, 1990 and July 31, 2002. RESULTS: Impacted cerumen is commonly seen in primary care settings. Between 1.2 million and 3.5 million people in the UK suffer from impacted cerumen. Moreover, 2.3 million people in the UK suffer cerumen problems serious enough to warrant management, with approximately four million ears being syringed annually. Impacted cerumen causes unpleasant symptoms and is occasionally associated with serious sequale, such as hearing loss, social withdrawal, poor work function and perforated eardrums. The physiology, clinical significance and management implications associated with excessive and impacted cerumen remain poorly characterised. The evidence supporting the traditional view that cerumen plays a biologically or clinically significant role in host defence is weak; rather the consensus seems to be that if anything, cerumen offers a rich medium supporting microbiological growth. CONCLUSIONS: Patients with impacted cerumen clearly require effective treatment. However, given a dearth of rigorous evidence in the literature any attempt at a systematic assessment of optimal management strategies is exceedingly difficult. The evidence surrounding the pharmacological management of impacted cerumen is inconsistent and few conclusions can be drawn. There is clearly a need for a definitive assessment of the most effective pharmacological strategy for cerumen removal. Lastly, the causes and management of impacted cerumen require further investigation.