Excessive earwax may impede the passage of sound in the ear canal, causing mild conductive hearing loss, pain in the ear, itchiness, or dizziness. Untreated impacted wax can result in hearing loss, social withdrawal, poor work function and even mild paranoia. Some people with impacted wax present with perforated eardrums; the reason for this is usually self-induced as compacted earwax alone cannot perforate the eardrum, for example due to the use of earbuds. Physical exam usually checks for visibility of the tympanic membrane which can be blocked by excessive cerumen.