Several methods can be used to remove excess ear wax. GP surgeries, hospitals, and private clinics commonly use irrigation and Staffordshire ear cleaning but micro suction is also an option.
Ear irrigation is a quick and effective method to remove excess earwax. However, a thorough history must be taken to ensure that the eardrum is intact.
What is Microsuction?
Microsuction is the most efficient method of removing ear wax. It is very quick and painless and is a great alternative to ear irrigation. It is the safest way to remove ear wax as it prevents the nurse from accidentally damaging the ear canal or ear drum. It also reduces the risk of damage to the eardrum caused by patients using cotton buds, which can cause a ruptured ear drum.
Ear irrigation involves a pressurized flow of water into the ear canal to flush away ear wax. Performing successful irrigation is very difficult as there are many risks involved with the procedure, such as a ruptured ear drum, infection, and perforation of the tympanic membrane. It is important that nurses who perform ear irrigation are trained to use the correct equipment and know how to correctly prepare the solution to ensure it is at the correct temperature.
It is also recommended that the ear canal is straightened before irrigation is carried out to avoid the solution entering a narrow canal entrance. Irrigation should only be performed if the patient consents. It is not advised to perform ear irrigation for a patient with a perforated tympanic membrane or a mastoid cavity opening as there is a high risk of re-perforation of the tympanic Membrane. This is why irrigation has been discouraged by the National Institute of Health and Care and patients are advised to seek safer alternative options like microsuction.
What is Ear Irrigation?
Ear Irrigation is a relatively simple procedure that medical professionals, usually nurses, perform for patients who complain of a buildup of ear wax. This ear wax, or cerumen, helps protect the middle and inner ears from bacteria and dirt particles that may block hearing.
The ear irrigation technique involves flushing the external ear canal with a saline or hydrogen peroxide solution. The patient lies down, and the medical professional places a small basin or plastic cup directly under the ear. Then, the medical professional fills the container with the solution and either inserts a bulb syringe or an irrigating syringe into the outer ear canal. Then, the patient tilts their head to one side and gravity causes the saline or hydrogen peroxide to flow into the ear canal.
Medical professionals should always be careful when performing ear irrigation to avoid injuring the ear drum or lining of the ear canal. If the ear wax is too hard, a medical professional should first use a cerumenolytic to soften it before attempting to flush it out.
Ear irrigation is not recommended for individuals with a perforated or ruptured ear drum, tympanostomy tubes, mastoid cavity issues, or cleft palate and can lead to a loss of hearing or even tinnitus (ringing sound inside the ear). Also, it is not possible to know if the impacted ear wax has foreign debris lodged within.
How is Microsuction performed?
In microsuction we insert a small, pencil-like probe into the opening of your ear canal and use a powerful suction device to remove wax. This is a ‘dry’ procedure which means no water is used or flushed into the ear canal, and as such there is much less risk of infection. This also makes it safer for those with a perforated ear drum, or who have had previous ear surgery (such as a grommet) or trauma to the ear canal.
During the microsuction process you may feel a sucking sensation, and sometimes some clicking or popping in your ears as the ear wax is removed. We may also use sterile saline solution to help soften and break up the wax or debris before suctioning it away.
This is a safe, effective and quick procedure which takes only minutes. Microsuction is the preferred method of removing ear wax amongst ENT surgeons and is far more effective than alternatives such as ear irrigation which can damage earwax, cause infection and can worsen tinnitus (ringing in the ears) which can last for weeks or even years.
Ear irrigation is a very common practice in GP surgeries and hearing clinics but it is recommended to avoid this if you have a perforated eardrum, a mastoid bone or tympanic membrane rupture (or have had previous ear surgery). It can cause a sudden pressure build up, which can rupture the tympanic membrane, damage your ear canal and the eardrum and can lead to permanent tinnitus or cause a temporary loss of balance and dizziness.
How is Ear Irrigation performed?
During ear irrigation, your doctor will use a syringe-like device to spray water or saline solution into your ear canal. This dislodges the earwax and flushes it out of the ear. Your doctor will also check inside your ear canal to make sure that there isn’t something more serious, like a blockage or infection.
The procedure may be uncomfortable and your ear canal will feel full afterwards. However, you should only feel this for a few minutes. If you experience dizziness or reduced hearing, contact your doctor immediately.
Because ear irrigations can be harmful if performed incorrectly, some healthcare systems have created educational modules that nurses and medical assistants (MAs) must complete before they are allowed to perform the procedure. These educational modules include education on the anatomy of the ear canal and how to properly execute an ear irrigation.
Conclusion
Ear irrigations can be done at home or by a health professional, but they should only be attempted in individuals who have healthy ear canals and don’t have any risk factors for an ear injury, including a perforated eardrum. Individuals with immunosuppressive illnesses (like HIV, diabetes, or cancer), who have had an ear surgery, or those taking anticoagulants and blood thinners are at higher risk for developing a hematoma or other complications from ear irrigation. Additionally, children should never attempt to remove their own earwax because it could damage the eardrum or cause hearing loss.
