Frequently Asked Questions

Cerumen, commonly known as ear wax, is formed by secretions from the ceruminous and pilosebaceous glands and is often mixed with dirt, skin cells, glandular secretions and other debris which when combined forms a sticky, waxy substance. Ear wax is produced naturally and its role is to lubricate the ear canal, keep it clean and prevent a wide range of bacteria forming which can cause ear infections. These antimicrobial properties are maintained by an acidic pH level in the ear canal of around 6.1, along with the presence of saturated fatty acids and lysozymes.

Yes, that’s correct. You may have been raised to believe - and make part of your daily cleaning routine – that you need to clean inside your ears. Be that with a cotton bud (q-tip), bobby pin, pen lid, paper clip…. the idea of your ears being able to clean themselves may sound far-fetched.

Let me explain. The skin in the ear canal moves outwards and takes the ear wax with it, like a conveyor belt, towards the outside of the ear. It not only transports the ear wax, but also dirt, bacteria and other debris, at a rate of about 34mm per year. 

An issue occurs when the skin doesn’t break apart and gets stuck on the conveyor belt, which doesn’t stop moving. Other bits of skin then build up on top of each other and accumulates in the canal. This cluster then collects dirt, dust, other foreign debris and bacteria which makes it more difficult for the natural migration out of the ear and gradually becomes impacted.

At this stage the build up of ear wax may be causing you symptoms such as; a sensation of blocked ears, hearing loss, itchiness, tinnitus or ear pain. Not being able to see exactly how much or where the ear wax is, means you will most likely push the ear wax further down the canal. This will lead to more discomfort and impaction that will require manual removal or worse can cause a perforation in your ear drum – ouch!

A study found that of 949 people with a perforated ear drum, 261 of those were caused by the person trying to ‘clean’ their ear canal using a cotton bud.

Also remember that ear wax is naturally produced as a protectant that prevents ear infections. It’s best to leave the pen lids on the pens and paper clips on the paper and let the self-cleaning mechanism work its magic. If you are concerned that you may have wax impaction, please call our Clear Ears Perth clinic to book an appointment with our experienced audiologist. We will gently be able to remove the bothersome ear wax build up, under direct vision, using specialized instrumentation and equipment.

Read more about Ear Wax Dos and Don’ts.

Don’t worry, it is not due to poor personal hygiene. The ear canal has a self-cleaning mechanism. Cerumen impaction affects approximately 10% of children, one third of elderly people, and one third of people with an intellectual disability.

Ear wax is produced naturally and protects the ear drum and external auditory canal from infections and foreign objects. There are many causes attributed to the excessive build-up of ear wax. These include; the overproduction of ear wax, a person’s ear anatomy (narrow ear canals, bony growths), exostoses, which are common in surfers, osteomas, ear infections, canal stenosis, surgery to the ear canal, mastoid cavities or hairy ear canals.

The use of cotton buds can push wax further into your canal and disrupt the self-cleaning mechanism and cause impaction. Over enthusiastic ‘ear cleaners’ can also irritate the skin, cause infections or even accidentally damage the tympanic membrane (ear drum). As the old saying goes, nothing smaller than your elbow should go in your ear. 

Wearing hearing aids, ear plugs or ear buds can also prevent the natural migration of ear wax out of the ear canal. Ear wax impaction in hearing aid users can cause the loud whistling noise (feedback) that can be heard by others and blocks the sound bores of the hearing devices, which decreases the sound quality and makes it even harder for you to hear. This feedback can be annoying for not only yourself but others around you. Ear wax removal can help both the sound quality of your hearing aids and prevent the embarrassing whistling noise from happening, especially when you go to hug someone.

Even if you don’t wear hearing aids, ear wax impaction can greatly affect your hearing. It is shown that a person’s hearing can deteriorate by as much as 40-45dBHL, causing a mild hearing loss, which is the equivalent to placing your fingers in your ears to block them (which makes sense). However, if you already have a mild hearing loss, the additional reduction in hearing from wax impaction can have a detrimental effect on your ability to communicate.

Having excessive ear wax can lead to an inaccurate hearing test result. Therefore, it is important that if you feel your hearing is reduced from ear wax, that you have the wax removed prior to going for a hearing test. This will ensure that an accurate hearing test result (audiogram) is obtained and any underlying causes for the hearing loss can be determined.

Elderly patients, young children, and the cognitively impaired are at high risk of ear wax impaction. Some of this at-risk population are unable to express the symptoms associated with ear wax impaction, or may be unaware that they have excess ear wax and that removal can improve their hearing. The deterioration in hearing with ear wax impaction can lead to issues communicating and may further impair cognitive function.

Rest assured if you have an ear infection this will be identified during otoscopic examination in your appointment with us and we will recommend that you visit your GP for medical treatment. A report to inform your GP will be arranged.

Ear drops (cerumenolytics) are liquids that are used to soften ear wax and are marketed as the solution to your ear wax impaction issue. There are a multitude of ear drops to choose from and which are made from solutions that are; oil‐based, water‐based, a combination of oil and water, non‐oil‐based such as carbamide peroxide and glycerol. Ear drops are used to break down impacted cerumen to try and prevent the need for irrigation or manual removal. Ear drops can be used in combination with ear wax removal but it is not essential.

No cerumenolytics that are commercially available, even solutions with active ingredients, have been shown to be more effective than water or saline. Therefore, it is recommended that plain or salty water is the ‘best’ ear drops to use. The amount of time you use ear drops has been shown to have little impact, which means there is no timeframe that you need to use ear drops prior to your appointment for ear wax removal. We can arrange a same day visit as there is also no evidence that water or saline are better than doing nothing at all to treat ear wax impaction.

No. This ‘alternative method’ for wax removal is ineffective and can potentially be dangerous. Ear candling claims to relax the body, remove ear wax, relieve tinnitus and vertigo by burning one end of a hollowed out candle placed in the ear canal, to create a negative pressure in the ear. The candle will then ceremoniously be cut open to reveal what seems to be ear wax, however this has proven to be false. By lighting the same candle in an empty beaker, the apparent ‘ear wax’ is there once cut open. Having a hot candle burning near the ear and face also puts you at risk of having candle wax dripping onto your face or even worse, back into the ear canal.

Read more about Ear Wax Dos and Don’ts.

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.

Ear 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 ear 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. 

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.