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If you’ve ever had ear wax impaction, it can be very unpleasant and lead to symptoms that include a feeling of fullness in the ear/s, hearing loss, ear pain (otalgia), itchy ear canals, dizziness, tinnitus, and an increased risk of an ear infection (otitis externa).
What is Ear Syringing?
Ear syringing (ear irrigation or ear toileting) has long been the most commonly used technique to remove impacted ear wax. However, there has been a shift away from this practice among GPs. This is thought to be due to advancements in equipment, the fact 1 in 1000 patients who undergo ear syringing experience major complications and that 1 in 5 medico-legal cases involving GPs are related to ear syringing.
Ear syringing is performed using a stream of water that is squirted in the ear canal in an attempt to flush out the ear wax. With this method there are several risks.
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Firstly the water can be pushed back into your ear canal, resulting in pain and no resolution to your initial problem. If the water being used is not at body temperature it can evoke a vestibular response (dizziness and/or nausea) by stimulating the semicircular canals.
This procedure is done without direct vision of the tympanic membrane, therefore the clinician is unable to see what is happening during the procedure. If the water is not administered correctly it can cause a perforation (hole) in the delicate structure of the tympanic membrane (ear drum). This can be caused from aiming the water in the incorrect direction, or if the stream of water is prevented from coming back out of the ear canal and the pressure build-up causes the ear drum to burst.
It is known that a warm, wet environment is the perfect incubator for bacteria which could lead to an ear infection. The pH level of the ear canal is naturally acidic to prevent the build up and spread of bacteria causing an infection. By using irrigation, this upsets the pH levels which can change, and can put patients at risk of an ear infection.
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The equipment used to carry out manual removal of ear wax is not always available in GP clinics. GPs may not find purchasing this equipment as cost effective, or find that performing the manual removal of ear wax is not an efficient use of consultation time. Manual removal of ear wax via an ear curette and microsuction can itself be risky if performed by an inexperienced clinician, and the instrumentation required needs specialised training to operate.
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If you have not had success in the past with ear syringing or you have been advised against having it done by your GP, manual removal of ear wax may be appropriate.
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Similarly, if you have tried using the many wax softening drops (cerumenolytics) available and still are suffering from blocked ears, an ear health consultation would be beneficial.
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Using microsuction to remove ear wax is safer because it utilizes state of the art equipment and it is performed under direct magnified vision, making it overall more effective. Other treatments, such as ear wax softening drops, only provide a temporary solution where microsuction ear wax removal can be done quickly and avoids exposing the ear canal to moisture, therefore reducing the risk of infection.
What is Ear Microsuction?
When it comes to managing cerumen impaction, healthcare professionals have traditionally relied on cerumenolytics (softening agents) and ear irrigation - both of which come with side effects.
Now, a safer, more effective and advanced technique - microsuction - is emerging as a more precise and patient-friendly alternative.
In this article, we'll delve into the benefits of cerumen microsuction versus traditional ear irrigation, shedding light on why this method is becoming the preferred choice for both practitioners and patients.
Microsuction is an advanced and non-invasive technique designed for the precise removal of impacted ear wax. Utilizing a device with a low-pressure suction system, this method offers a controlled and efficient approach. The process involves a thorough examination of the ear canal through a speculum, using a head worn Converged Binocular Optical system that operates like a microscope and allows both eyes to clearly see deep into the ear. The view is further enhanced with LED illumination, creating a shadow free view of the cavity.
Once problematic cerumen has been identified the microsuction procedure is explained to the patient and commenced, with a suction tube placed through the speculum and into the ear to gently and carefully remove the cerumen.
What are the Benefits of Ear Microsuction Vs Ear Irrigation?
Microsuction offers numerous advantages over ear irrigation, also known as ear syringing. These include the ability for the practitioner to monitor the removal process in real time, ensuring targeted and safe removal, as opposed to syringing, which does not allow the clinician to visualise inside the ear.
Ear syringing also poses risks due to the use of water, which can lead to infection or inflammation - particularly in those with a history of ear surgery or infections. Water flow and pressure can also exacerbate perforated eardrums, potentially re-rupturing the tympanic membrane and resulting in water entering the middle ear.
Furthermore, in the case of foreign bodies in the ear canal, irrigation can cause additional complications by pushing the object further into the ear.
Patients undergoing the gentle and non-invasive microsuction are further benefited in that there is no need for wax softeners to be used prior, meaning the procedure can offer immediate relief and a vast improvement in their ability to hear - with no need for further appointments or use of ear drops.
What to expect at your Ear Wax Removal appointment
Please read the below information that provides you with an overview of what to expect in the typical Ear Wax Removal appointment.
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First you will be asked some questions about your ear health and what has brought you to the clinic.
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An otoscopic examination will determine whether or not you have ear wax build up. We use an otoscope, which is a hand held magnified torch that is used to look in your ears.
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A manual technique is used to remove ear wax, with no water. Depending if the wax is hard or soft and the amount, either microsuction, a curette or forceps (rarely) will be used to remove the ear wax under direct, magnified vision.
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A head worn torch that has binocular vision allows depth perception and for us to see exactly what we are doing.
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A speculum is placed in your ear canal which gives us a better view of the ear. Sometimes this can be uncomfortable, but we can change size and readjust until you are happy to proceed.
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The microsuction machine itself is loud (like a mini vacuum cleaner) and can startle young children, therefore it is more appropriate to use curettage in children.
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Micro-suction involves the suction tip being placed gently into the wax which is then sucked into the machine or allows the wax to be gently drawn out.
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Curettage is used when the wax is closer to the entrance of the ear canal and allows the wax to be gently moved and scooped out of the ear.
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At any time during the procedure we encourage you to say ‘STOP’ rather than make any sudden movements. We are happy to stop as many times as you’d like.
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The vacuum in the ear will sound like a loud ‘whooshing’ noise, that can sound high pitched at times when it suctions the ear wax. Don’t be alarmed by the noise, it is normal and once the ear wax is removed, you may be able to hear it louder than when we started.
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Rest assured that if at any point you feel uncomfortable, you may stop.
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Occasionally our audiologist will recommend using wax softening drops for a period of time if the wax is particularly hard and impacted. This will soften the wax and make the process more comfortable at a later date. Ear wax softening drops can be purchased over the counter at your local pharmacy.