— Microsuction Ear Wax Removal Network (@microsuction) 18 June 2016
The Microsuction Ear Wax Removal Network are the first clinics in London to be able to offer endoscopic ear wax microsuction and private endoscopic ear wax removal using instruments by request at selected locations.
Endoscopic microsuction has been shown to be more comfortable than microsuction using an operating microscope or surgical loupes, and is particularly suitable for clients with narrow ear canals.
Private endoscopic ear wax removal using instruments is particularly suitable for clients with severe tinnitus and/or noise sensitivity, where microsuction may not be appropriate due to the noise levels. The instruments used are the St Barts wax hook, the Jobson Horne probe, and crocodile forceps (due to the high cost of the crocodile forceps, an additional charge of £10 is applied if its use is required).
Where there is a foreign object in the ear canal, it may also be necessary to use instrumentation, especially the crocodile forceps.
A 2010 Health Technology Assessment by AJ Clegg et. al. concluded that endoscopic ear wax removal is superior to microscopic wax removal – microscopic wax removal uses an operating microscope or surgical loupes to get a magnified view of the ear canal and ear drum – a speculum (small funnel) must be inserted into the ear canal in order to provide a view, and the speculum takes up some of the space within the ear canal, further restricting the practitioner’s view. Furthermore, the speculum can sometimes cause minor trauma to the skin of the ear canal if the ear canal is very narrow.
In contrast, endoscopic ear wax removal uses a fine 2.8mm endoscope inserted part way into the ear canal. The endoscope is a rod containing fibre optics to relay light from a light source to illuminate the canal and a solid lens (or series of lenses) to relay the view from inside the canal to the outside. The endoscope can be either viewed directly, or imaging equipment (such as what you see below) can be attached to provide better magnification.
There are numerous methods of ear wax removal. Some can be performed at home, while others must be performed by a professional. Here we have outlined the different methods and the pros and cons of each one:
Ear drops can be bought from the chemist over the counter and are the cheapest method of wax removal. Ear drops are commonly marketed as a cheap way of removing earwax at home. For an ordinary member of the public, the choice of different branded and unbranded products can be overwhelming. Here are some of the different types:
Olive oil ear drops are the gentlest type. The olive oil softens the edges and outer surface of the wax and is well-tolerated by most people. Some more expensive versions have added menthol to produce a cooling sensation, or eucalyptus to give a pleasant smell.
Pros: cheap; gentle; generally well-tolerated; can be used for extended periods
Cons: can take a long time to work on its own; can make the ear feel bunged up,;added ingredients may not be so well-tolerated
Other Oil Blends
Some proprietary brands contain blends of light oils that soften ear wax.
Pros: gentle; possibly faster acting than olive oil
Cons: more expensive than olive oil; wax can sometimes dissolve and slide further down the ear canal, rather than coming out;
Sodium bicarbonate / bicarbonate of soda ear drops are alkaline, while ear wax is acidic. Therefore they work by chemically dissolving ear wax rather than softening it, and work much quicker than olive oil. They can be used for a day or two by most people without any problem.
Pros: also cheap; tolerable for a day or two; quick
Cons: wax can sometimes dissolve and slide further down the ear canal, rather than coming out; extended use can strip the protective lining of the ear canal and lead to infection
Some ear drops, including proprietary and chemist own-brand, are based on peroxide in some form, often urea peroxide. When compared to sodium bicarbonate drops, peroxide-based drops are similarly effective, but also effervesce.
Cons: more expensive than sodium bicarbonate drops; wax can sometimes dissolve and slide further down the ear canal, rather than coming out; contain peroxide (bleach), and some individuals can experience a painful reaction even immediately after one application. For this reason we don’t recommend peroxide-based drops
In general, ear drops can sometimes take weeks to work, and hearing will often get worse before it gets better. There is also the possibility that the wax will slide further down the ear canal, form one large lump, and completely block the ear. Ear drops are not recommended if you have a perforated ear drum.
Ear sprays can be water-based or oil-based. They usually incorporate a conical nozzle that is placed into the entrance of the ear canal and the spray is then applied.
Water-based ear wax removal sprays can be effective if the amount of wax blockage isn’t too great. They are often simple saline, or may be sterilised sea water.
Pros: gentle; salt water based; well tolerated
Cons: may push wax further into the ear by the force of water; water may get trapped behind wax and create a “head under water” feeling
Oil-based ear wax removal sprays, such as Earol, are great for softening wax prior to other procedures, and are very effective at penetrating wax due to their small droplet size.
Pros: cheap; safe; penetrate wax better than drops; reach further into the ear because of spray; great preventative measure when used once a week
Cons: may not remove wax on their own
Ear Syringing / Ear Irrigation
Ear irrigation is normally performed by a GP practice nurse, a disrict nurse, and by some Audiologists. Traditionally, a meal ear syringe was loaded with warm water, the metal tip placed into the ear canal. The water was then squirted into the ear canal and a kidney dish was held under the ear to catch the water and and wax that was flushed out. The syringe would have to be regularly lubricated to allow a smooth level of pressure to be applied, and the nurse would use his or her judgement as to how forcefully to syringe the water. Syringing can’t shift hard wax, so it must be softened for up to two weeks before syringing is performed. Nowadays, for safety reasons the metal ear syringe has been replaced by an ear irrigator pump with a jet tip. The pump has a variable, regulated pressure, but the process is essentially the same. Many people have had their ears syringed or irrigated many times without any issue arising. Here are the pros and cons of ear syringing:
Pros: usually free on the NHS; when it works it works well
Cons: cannot remove hard wax; can push wax further into the ear if the angle of the jet is slightly off; may cause tinnitus; may perforate the eardrum; an undiagnosed perforated ear drum may not be seen due to the amount of wax, causing water, bacteria, wax and dead skin cells to be flushed past the eardrum into the middle ear, potentially causing a painful infection; not recommended following ear surgery; should not be performed when the ear drum has previously been perforated due to the risk of re-perforation
Due to the long list of potential complications listed above, many surgeries are withdrawing their ear syringing service, and are referring all patients to the NHS ENT clinic, which may have a long waiting list.
Dry Instrument Removal
Dry instrument ear wax removal is normally performed by an ENT surgeon or an Audiologist. The pratitioner uses a selection of different shaped instruments called Jobson Horne probes or curettes. These are like miniature spoons and loops that are used to hook or scoop the wax from the ear canal. It is normally perfomed under illumination. There is a great choice for the practitioner of metal, or plastic disposable curettes, and some of them even have their own light built in. The practitioner will usually apply some Earol to loosen the wax from the ear canal wall before performing the procedure. The tip of the curette is normally pushed past the wax and the drawn back out, bringing the wax with it.
Pros: quiet – so great for those who don’t like noise; quick – often the wax can be removed in one or two big lumps
Cons: small possibility of pushing the wax deeper into the ear; hard wax may be uncomfortable to remove
Micro Suction Ear Wax Removal
Microsuction is by far the most effective method of earwax removal. Tradionally only performed in ENT clinics due to the size and weight of the equipment, it can now be performed by appropriately trained individuals in smaller clinics due to portable suction pumps and operating microscopes that are now available. Continue reading “Methods Of Ear Wax Removal” »