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Ear Care Academy Aural Microsuction Course – December 2019

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Ear Care Lab’s training organisation, the Ear Care Academy is delighted to announce the next available course for aural microsuction. This 2 day course will be on Saturday the 7th December 2019 and Sunday the 8th December 2019. Operating from a world class teaching hospital set up, the course will take place at the NHS Charing Cross Hospital, London Imperial College Healthcare Trust, Audiology and ENT department. The course is open to national and international audiologists, hearing aid dispensers, GPs, nurses, advanced nurse practitioners, pharmacists, paramedics and physicians assistants. Please visit our website to book your place and please note that places are limited.  We now run this course four times a year.

www.earcareacademy.co.uk

If you would like to discuss the course with our organisers, please email: [email protected]

Ear Wax and how to remove it safely

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At Ear Care Lab, we are experts in all matters relating to ear wax and its safe removal. We have safely treated thousands of patients over several years and are proud to offer a service that is second to none.  This article details all you need to know about ear wax, its symptoms and its removal. 

What is Ear Wax?

Ear wax is a waxy material produced by sebaceous glands inside the ear.  It cleans, lubricates and protects the lining of the ear by trapping dirt and repelling water.  Ear wax is slightly acidic and has antibacterial properties.  Without ear wax, the skin inside your ear would become dry, cracked, infected or waterlogged and sore.  It is extremely important to remember that due to its protective properties, a thin layer of wax left on the lining of the ear canal, following procedures such as syringing and microsuction, is extremely beneficial.  The aim of ear wax treatment is not to completely eliminate ear wax.

Ear wax can be wet or dry, hard or soft. Soft ear wax is more common in children and hard ear wax is more likely to cause problems.  Everyone makes ear wax but the amount and type are genetically determined just like hair color or height.  Some people have ear canals that are smaller than average or shaped in a way that makes it difficult for the naturally occurring wax to get out of the canal, causing wax impactions.  Some people produce more ear wax than others. It usually falls out of your ear gradually, in small pieces or flakes. Sometimes, ear wax can build up and harden, creating a blockage called a “plug”.  As well as causing discomfort, an ear wax plug can also cause temporary hearing loss because it blocks your ear canal. Once the blockage is removed, your hearing will improve.

Causes of Ear Wax

Some people are naturally more susceptible to developing a blockage in their ear, for various reasons.  Blockage, or impaction, also occurs when the wax gets pushed deep within the ear canal.  Ear wax  blockage affects about 6% of people and is one of the most common ear problems doctors see.  Your risk of developing problems from a build-up of ear wax is increased if you have:

  • narrow ear canals or ear canals that aren’t fully formed
  • a lot of hair in your ear canals
  • bony growths in the outer part of your ear canal – these are called osteomata
  • a skin condition of your scalp or preauricular area
  • hard wax
  • a history of recurrent impacted earwax
  • repeated ear infections

Elderly people are more at risk of having ear wax problems because ear wax becomes drier with age.  Your chances of developing an earwax blockage are also increased if you:

  • Use cotton buds – they can push ear wax deeper into your ear and pack it together harder, creating an ear wax plug
  • Wear a hearing aid or earplugs, which can stop ear wax falling out of your ear naturally

Ear Wax Symptoms

Ear wax doesn’t usually cause problems, but a build-up of ear wax can lead to a blocked ear or fullness sensation, ear pain/discomfort and hearing loss.  Too much ear wax can also cause other symptoms, including:

  • Ringing in the ear
  • Itching or drainage from the ear canal
  • Vertigo or Dizziness

Treating ear wax build-up

In most cases, ear wax falls out on its own, so there’s no need to remove it. However, if it’s completely blocking your ear canal and causing hearing loss or discomfort, it may need to be removed.  Indications for earwax removal include:

  • Difficulty in examining the full tympanic membrane (ear drum)
  • Otitis externa – external ear canal infection
  • Wax occlusion of the external ear canal
  • As part of the workup for conductive hearing loss
  • Prior to taking the impression for hearing aid fitting
  • Suspected external ear canal or middle ear cholesteatoma
  • As part of grommet insertion or middle ear surgery
  • Patient request

Ear Wax Removal Treatments

Ear Microsuction

Ear Microsuction is where a special suction device is used to remove the ear wax under a microscope or a special light loupe with magnification. The procedure is quick, safe and painless.  This technique is offered by the Ear Care Lab as the safest and most efficient method of removing ear wax.

Aural Toilet

Aural Toilet treatment uses an instrument called a Jobson Horne probe. A Jobson Horne probe is a thin metal or plastic instrument with a small ring at one end that the specialist can use to remove earwax from your ear canal.  We sometimes have to use instruments like this in order to gently help wax come out.

Ear drops for Ear Wax Removal

Ear drops can be used to soften and loosen the ear wax.  Ear drops should not be used if you have a perforated eardrum.  Ear drops vary in composition from olive oil, to sodium bicarbonate to hydrogen peroxide based drops available in many pharmacies.  Olive oil is generally completely harmless but sodium bicarbonate and hydrogen peroxide based drops can be quite irritant to the ear canal so must not be used for prolonged periods.

Ear Syringing

Ear irrigation or Ear Syringing is often used in many GP surgeries.  Ear Syringing involves using a pressurised flow of water to remove the build-up of ear wax. Ear Syringing is not as effective as Ear Microsuction in many cases.

What is Ear Microsuction?

Microsuction is a technique for removing ear wax or debris using either an ENT (Ear Nose and Throat) binocular operating microscope or specialised magnification loupes (similar to the type dentists use). This allows the clinician to look in the ear canal in great detail and use a very fine sterile suction device at low pressure to remove the wax.  This process is not dissimilar to using a tiny vacuum cleaner inside the ear to remove the wax.  Occasionally we may need to use other instruments to remove hard wax (such as Jobson Horne probes or micro forceps).

Using microsuction means that we can visualise the external ear canal and its contents in great detail while having minimal physical contact with the earlobe. This makes the process more comfortable for patients. Preparation of wax with olive oil ear drops is not usually necessary but may make the procedure faster and more comfortable for the patient. This is discussed in more detail in the FAQ section.

Why is Ear Microsuction Better Than Ear Syringing?

There are a variety of reasons why microsuction is superior compared to the traditional forms of wax removal (e.g. ear syringing or irrigation, ear drops).  Ear microsuction is:

  • safer
  • faster
  • better tolerated
  • more effective
  • usually does not require weeks of waiting for drops to soften the wax. It may be performed on the same day you decide to book your appointment

Are your ears blocked with wax? Do you have reduced hearing? Why suffer? Ear Microsuction is the best method of ear wax removal compared with ear syringing or ear irrigation

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At Ear Care Lab we provide safe, effective ear microsuction to remove ear wax or other causes of ear blockage and to treat external ear infections. Microsuction ear cleaning is the safest method of removing ear wax. This method of ear cleaning usually requires no preparation (i.e. olive oil or other types of ear drops prior to your appointment). Our Ear Microsuction Clinic in Ealing has successfully provided ear wax removal for thousands of patients over a number of years. All our consultations and ear cleaning / ear wax removal services in Ealing, London are with highly experienced microsuction specialists. Our team consists of GPs with a specialist interest in ENT Medicine as well as our Senior Specialist Audiologist. We are experts in ear wax removal and this is why other clinicians come to us to be trained, via our gold standard Ear Care and Microsuction Training Course.

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Ear Microsuction Wax Removal at Ear Care Lab

Ear Care Academy – Our Next Gold Standard Ear Microsuction Course is on 2nd and 3rd March 2019 – Charing Cross Hospital – London

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Our training organisation, the Ear Care Academy is delighted to announce the next available course for aural microsuction. This 2 day course will be on Saturday the 2nd March 2019 and Sunday the 3rd March 2019. Operating from a world class teaching hospital set up, the course will take place at the NHS Charing Cross Hospital, London Imperial College Healthcare Trust, Audiology and ENT department. The course is open to national and international audiologists, hearing aid dispensers, GPs, nurses, advanced nurse practitioners, pharmacists and physicians assistants. Please visit our website to book your place and please note that places are limited.

www.earcareacademy.co.uk

If you would like to discuss the course with our organisers, please email: [email protected]

Microsuction Ear Wax Removal in Ealing with Ear Care Lab

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Dr Alex Fragoyannis, a GP in Ealing who specialises in microsuction ear wax removal.  He explains more about the dedicated service he has set up and how DP Medical is involved.

 

I am a GP partner in Corfton Road Surgery in Ealing and have had a specialist interest in ENT Medicine since before qualifying as a GP in 2006.

I have informally been performing ear microsuction wax removal for several years but two years ago I decided to set up a dedicated ear microsuction service – Ear Care Lab. This was in order to fulfil a growing demand for microsuction from patients not registered with our practice.  Another reason for setting up this dedicated service was to help reduce onward hospital referrals for microsuction to already over-pressured ENT departments.

DP Medical supported us by visiting our clinic and explaining the requirements of a full microsuction setup from consumables (tubing, suction probes), to suction devices and ENT microscopes.  They provided exceptionally good package prices for these items and we use all their equipment including the excellent SOMRON ENT microscope on a daily basis.

Our ambition has always been to disseminate our knowledge to other clinicians and as such, we have created the UK’s first fully accredited Ear Care and Microsuction Course under our new training branch – Ear Care Academy

 

Our course is delivered on real patients and offers closely supervised hands-on experience over an intensive two days training at Charing Cross Hospital. DP Medical kindly provide ENT microscopes and suction equipment for our course and enable delegates to experience the equipment they might use in their own practices.  We feel their equipment provides an excellent combination of quality, functionality and value for money and it’s been great to build a really successful relationship with them.

Microsuction is the best method of ear wax removal

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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.

 

Ear microsuction to clear ear wax – Book now

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Ear Care Lab has now been open since mid-October 2016, offering ear microsuction to clear ear wax or other causes of ear blockage! Our first six weeks have been exceptionally busy, seeing patients with a large variety of ENT-related issues ranging from blocked ears, ear infections, tinnitus and dizziness.  We have seen patients for microsuction from all over London (and outside too).  Patients are able to self refer and book via our website or by calling 0208 004 7808.  Many patients have been referred to us by their GPs or by Urgent Care Centres.  We have even seen patients referred by hospital ENT doctors!

Microsuction is superior to ear syringing for a variety of reasons which are detailed here.  We are also now offering Oto-endoscopic ear examination as well as wax and foreign body removal using this new innovative method.  Oto-endoscopy allows direct view of the ear canal and drum at much larger magnification than can be achieved by ENT microscopes and light loupes.  This will make the process of ear wax removal in tricky patients (e.g. with very narrow ear canals) far easier.  We are able to record video as well as take images of the ear canal and drum using this technique.

An example is shown below.