Impacted ear wax, leading to blocked ears and hearing loss as well as fullness and discomfort, is common. It is estimated that just under a third of older people experience the problem. In the UK thousands of people every week have ear wax removed. The chances of wax accumulating are increased by use of external objects in the ear canal including hearing aids and cotton buds. The traditional method of ear wax removal in most GP surgeries in the country is by irrigation (ear syringing). In the past, large hand-held metal syringes were used to manually inject water at high pressure in the ear. This was designed to flush out wax. These manual syringes resulted in variable pressure of water injected into the external ear canal. This caused large numbers of complications including external ear infections (Otitis externa), middle ear infections (Otitis media) as well as ear drum perforations. Ear syringing is now performed using Ear irrigation machines which apply a safer, more standardised pressure via special ear irrigator tips. Ear syringing/irrigation still results in rather a large number of complications.
Research data on ear syringing and other methods of ear wax removal
There is not much large scale data on the effectiveness of ear syringing. The last large study on this subject was performed in 1990 (Sharp et al, BMJ, Dec 1990, v301, 1251) where 312 GPs serving a population of 650,000 patients were surveyed in Edinburgh with some interesting data on the process and complication rates of ear syringing:
- 85 % of GP practices offer ear syringing but only around 19% of GPs actually perform the procedure – they usually delegate the procedure to practice nurses or healthcare assistants
- Failure of ear wax removal occurred in 29% of cases
- Otitis media and Otitis externa (middle and external ear infections respectively) occurred in 17% of cases
- Ear drum perforation occurred in 15% of cases
- Trauma to the external ear canal occurred in 11% of cases
A more recent systematic review (Cleg et al, Health Tech Assess, Jun 2010, 14 (28), 1-192) found limited good-quality evidence on the safety, benefits and costs of the different strategies of ear wax removal.
Expert opinion however is fairly consistent in terms of support for ear microsuction as the safest method of ear wax removal, resulting in the lowest prevalence of complications. No procedure is risk-free but ear microsuction offers several advantages over syringing:
- Microsuction may be used even in the presence of ear drum perforation
- It is the only technique safe to use for wax/debris removal in the presence of an external or middle ear infection
- Complication rates are vastly reduced in comparison with ear irrigation.
At Ear Care Lab, we only utilise ear microsuction in order to remove ear wax or debris (i.e. we do not perform ear syringing or irrigation). We are able to view the external ear canal under high magnification at all times during the procedure and also have the ability to utilise video-oto-endoscopes for even more detailed viewing. All our ear procedures and consultations are performed by experienced doctors (i.e. no nurses or healthcare assistants perform microsuction in our clinics).
Data from our own ear microsuction clinics shows that:
- We have no reported incidents of otitis media following microsuction
- We have no incidents of ear drum perforation
- Otitis externa occurs in less than 1% of our treatments. We also found that in those patients where otitis externa occurred following microsuction, the external ear canal was already inflamed prior to microsuction starting, as the patient had used sodium bicarbonate or hydrogen peroxide-based softening drops for longer than advisable. These drops are irritant to the ear canal skin after prolonged use, leading to inflammation, skin breakage and hence a higher risk of bacterial infection
- Failure of ear wax removal occurs in around 5% of our patients. Usually these patients have extremely hard/immobile ear wax and need softening ear drops prior to further attempts at microsuction. This rate falls to 0.5% at the second visit with only a handful of patients ever requiring a third visit.
Overall, it is our belief that ear microsuction is the gold standard method of removing ear wax or debris in order to achieve symptomatic relief from ear wax blockage and to treat external ear infections.