Ear Wax

Ear wax consists of secretions from the glands in the skin of the ear canal and the old skin (keratin). The ear canal skin has the unique property of moving sideways. The ear canal therefore cleans itself. For most people, therefore there is no need to clean their ear. The wax will migrate and fallout naturally. If the ear wax is visible it can be picked out with your finger. It is not recommended that you use cotton buds in an attempt to clean your ear. Although some wax might be removed with the cotton bud it’s likely that some has also been pushed deep into the ear canal. The old saying “nothing smaller than your elbow in your ear” applies.

Some people do have abnormal ear canal skin or their ear canal is very small which can lead to the wax becoming impacted. This can cause problems with hearing loss / blocked feeling in the ear. It may therefore be necessary to do something to prevent or treat this ear wax impaction.
Options to deal with this include:

  • Ear drops. There are many types of ear drops for wax. Some are water-based (e.g. bicarbonate ear drops); others are oily based (e.g. olive oil drops). It is commonly not recognised that ear wax dissolves better in water than in oil. Oily drops can still soften the wax which can help the removal of ear wax. Bicarbonate ear drops are fairly effective at dispersing wax and have the added advantage that if there is a perforated eardrum behind the blocked wax there is no known risk of damage to the inner ear. This is not the case for oily based drops where there is some risk of damage to the inner ear if the drops get in through a perforation. The water-based drops can on occasions, however, cause some irritation or even an infection. Ear drops can also be used to soften the wax prior to syringing. One way to prevent buildup of ear wax is to use a generous amount of  bicarbonate ear drops (10 to 20 drops) twice a day (leave in place for 5 to 10 minutes) for 2 to 3 days once a month, the idea being that the bicarbonate ear drops can get past the wax and help disperse it completely. Once the ear is almost completely blocked with ear wax the bicarbonate ear drops are not as effective. This is because the bicarbonate ear drops causes the ear wax to swell blocking the canal off completely.
  • Ear syringing. Self-irrigation is possible with over the counter preparations. See here and here. Traditional syringing is usually carried out by a professional e.g. a nurse. This is a traditional method of removing ear wax. It is usually carried out at the GP practice by a practice nurse. It involves squirting water into the external ear canal which then dissolves/rinses the ear wax. It is generally safe but there are potential problems. If there is a perforated eardrum then syringing should not be carried out. In addition if the eardrum has been previously operated on or is weak due to a healed perforation then syringing is also not appropriate. Even in normal ears there is a slight risk of causing infection or damage to the eardrum. It helps if some ear drops (e.g. bicarbonate ear drops 5 to 6 drops 3 times a day for 3 days) are used for a few days prior to syringing to soften the ear wax. This makes the syringing easier.
  • Microsuction. This is a technique which involves using a suction machine and microscope or endoscope to remove the wax under direct vision using a small suction tube. It is carried out by ENT doctors, audiologist or nurse practitioners. It has the advantage of being suitable for cases who have previously had damage to their eardrum or perforations as the technique does not involve squirting any water into the ear. It’s can be a noisy procedure and on occasions the ear canal skin may be scratched. There is a very small chance of damage to the eardrum and some patients have complained of tinnitus or even hearing loss after the procedure. As with syringing softening the wax with bicarbonate eardrops can make the procedure easier. Microsuction is available at some GP practices, hospital and via online providers e.g. clearwax. Mr Rejali is director of clearwax and provides training for clearwax practitioners.

Eawax removed with endoscope and microsuction