Having Your Ear Cleaned

Earwax, or cerumen as it is medically known, is a natural substance produced by the ear canal of humans and many other mammals. The exact function of earwax is disputed. Earwax probably plays a role in cleanliness, hygiene and overall health of the outer ear.

In most people the presence of earwax goes unnoticed and is non-problematic. In some people, however, the amount of earwax inside the ear canal can become excessive and impacted. This can be due to several reasons: 

• The skin lining the ear canal no longer migrates outwards when it sheds. The stopping of this ‘conveyor belt’ motion of the skin means the earwax becomes trapped inside the ear. 
• The anatomy of the ear canal does not lend well to the migration of earwax. E.g. the ear canal may be too narrow. 
• The inappropriate use of cotton/ear buds, or regular wearing of hearing aids and earplugs can push and impact the earwax deep in the ear canal. 
• The glands on the skin lining the ear canal become hyperactive and secrete more earwax than is normal. 
• The presence of hard and dry earwax, which is more common in older people, can impact inside the ear canal.

HOW DO I KNOW IF I HAVE PROBLEMS WITH EARWAX?

If excessive and/or impacted earwax is left untreated it can cause many symptoms. Symptoms of possible problematic ear wax include: 

• Hearing loss 
• A blocked sensation / Occlusion: internal sounds such as chewing, breathing, heartbeat and your own voice can no longer escape out of the ear due to the ear wax and are, therefore, heard much louder inside your head. 
• Tinnitus: a ringing/whistling/buzzing type of sound that originates from inside your ear and only heard by yourself.
• Vertigo: some people can experience vertigo (spinning dizziness), which improves with removal of the ear wax. 
• Coughing: irritation of the ear canal can cause coughing. 
• Interference with hearing aid: sounds being amplified by the hearing aid are reflected back out of the ear by the ear wax causing acoustic feedback (e.g. whistling) of the hearing aid. The ear wax can block the hearing aid tubing. 
• Itchiness/irritation: excess ear wax can contribute to itchiness and irritation of the outer ear canal (otitis externa).

If earwax is causing any of these problems then its removal should result in an improvement.

Other than earwax there are other possible reasons for the problems above.

HOW DO I TREAT EARWAX PROBLEMS?

In most people earwax causes no problem, it migrates out naturally and falls out of the ear. In most people there is no need to clean the ear with things such as cotton tipped ear buds. Ear buds will in fact cause some earwax to be pushed in to the deep ear canal and encourage impaction/blockage of earwax.

If earwax does cause problems there are a number of ways to deal with it.

Eardrops. Eardrops can help soften or disperse earwax. Broadly speaking, earwax drops are divided into water-based drops (e.g. Bicarbonate ear drops) or oily drops (e.g. Olive oil drops). The water base drops can dissolve ear wax. While oil base drops tend to soften the ear wax. Either type can help the ear wax impaction. If you have an eardrum perforation (a hole in the ear drum) oily based drops and some water based drops should not be used. Bicarbonate eardrops are not known to be dangerous but may be uncomfortable if you have an eardrum perforation (it can also trigger an infection).

Ear syringing (irrigation). This involves squirting a liquid into the ear canal to wash away earwax. This can be done by the person themselves (special kits can be purchased over the counter in pharmacists) or this can be done by a professional e.g. a practice nurse. It is effective. There are situations when ear syringing should not be used: 

• Perforated ear drum 
• Recently perforated ear drum 
• Very narrow ear canal 
• Previous mastoid or middle ear surgery 
• Infections of the ear 
• Previous problems with ear syringing 
• Sensitive ear (e.g. with pain) 
• Moderate or Severe Tinnitus that is made louder with noise exposure

Microscopic earwax removal. This involves using a microscope outside the ear canal to magnify the view of the ear canal. Instruments or suction are used to remove the earwax. With the appropriate training and equipment this technique is effective. In cases of people with sensitive ears or significant tinnitus that is made louder with noise exposure, the noise from suction may become uncomfortable. In this case special instruments can be used to remove the earwax without suction.

Endoscopic ear wax removal. This is similar to the microscopic earwax removal but an endoscope (an instrument to look into a parts of the body) is used to view the ear canal. The tip of this is placed in the ear canal allowing a significantly wider view of the external ear canal and eardrum. Instruments and suction are used to remove the wax.

The procedure will usually take between 10 to 15 minutes and is generally painless or causes mild discomfort.

Occasionally not all the earwax can be removed for example if it is hard. In this case it may be necessary to soften the earwax with some drops and return at a later date to have the ear cleared of earwax.

If the earwax is hard and impacted, softening of the earwax with eardrops (e.g. bicarbonate ear drops) will help its removal.
No single technique is 100% successful every time and in some people the combination of different techniques may be required to remove the wax e.g. ear drops to soften wax followed by removal with micro-suction. Occasionally the earwax cannot be successfully removed. Assessment by your GP or an Ear Surgeon maybe required.

It is usually not necessary or desirable/safe to remove 100% of all ear wax from the ear canal. Any earwax left may not cause problems and may migrate out naturally.

Earwax can often be removed without any prior treatment. Occasionally, if there is a large quantity of hard earwax, removal can be difficult. Earwax, which is hard, can be softened with bicarbonate eardrops. This can be obtained from most pharmacists. Three to 4 drops can be applied 3 times a day (and left in place for 10 minutes while lying on your side) for 3 day prior to the wax removal. Bicarbonate eardrops can cause the earwax to expand blocking the ear canal. Once the ear canal has been cleared this sensation of blockage will resolve. Some people can have sensitive ear canals, which may be irritated by bicarbonate eardrops. An alternative such as olive oil drops can be used.

WHAT PROBLEMS CAN BE CAUSED BY TREATMENT FOR EARWAX?

Ear wax removal is generally very safe. Occasionally problems can arise either immediately or within a few days of the earwax removal. If you experience any problems please inform the ear care practitioner. If you experience problems in the days after the earwax removal please contact you ear care practitioner for advice and make an appointment to see your GP urgently.

Eardrops. Eardrops are not always effective. In some patient eardrops can cause discomfort or trigger an infection.

Ear syringing. Ear syringing can in some cases cause problems. These include:

• Ear canal infection (otitis externa).
•  Ear syringing can cause a loud noise which in rare very cases causes hearing loss and tinnitus (ringing type noise in the ear).
• The eardrum may perforate, if already weak, causing ear pain, bleeding and in some cases hearing loss, tinnitus (ringing type noise in the ear) and dizziness.
• In cases of people with sensitive ears or significant tinnitus that is made louder with noise exposure, the noise from syringing may become uncomfortable.
• Occasionally the earwax cannot be removed. This may occur if the ear canal is completely full of hard wax. It may be necessary for the earwax to be softened with eardrops and a further attempt made at clearing the wax at a different time.

Microscopic earwax removal. This involves using a microscope (or magnifying goggles) to remove earwax. Occasionally microscopic removal of earwax can also on occasions cause problems. These include:

• Ear canal damage
• If microsuction is used, a loud noise can be generated in the ear canal. Very rarely this can cause hearing loss and tinnitus (ringing type noise in the ear).
• It is extremely rare for the eardrum to perforate. If this does occur it can cause ear pain, bleeding and in some cases hearing loss, tinnitus (ringing type noise in the ear) and dizziness.
• In cases of people with sensitive ear or significant tinnitus that is made louder with noise exposure, the noise from microsuction may become uncomfortable.
• In rare cases people can develop tinnitus after the treatment. People with existing significant tinnitus that worsens with noise or ears sensitive to sound should avoid wax removal techniques which generate noise (e.g. syringing or suction).
• Occasionally the earwax cannot be removed. This may occur if the ear canal is completely full of hard wax. It may be necessary for the earwax to be softened with eardrops and a further attempt made at clearing the wax at a different time.

Endoscopic earwax removal. Endoscopic earwax removal can also on occasions cause problems. These include:

• Ear canal damage. This can cause bruising, bleeding and pain. Sometimes an infection of the ear canal skin occurs. On very rare occasions this can lead to infection of the bone around the ear canal and damage to the nerve to the face resulting in facial weakness.
• If suction is used a loud noise can be generated in the ear canal. In some people this can cause hearing loss and tinnitus (ringing type noise in the ear). This is rare.
• It is extremely rare for the eardrum to perforate. If this does occur it can cause ear pain, bleeding and in some cases hearing loss, tinnitus (ringing type noise in the ear) and dizziness. The ear drum will, in most cases heal it-self. Occasionally an operation may be required to repair the ear drum.
• In cases of people with sensitive ear or significant tinnitus that worsens with noise, the noise from suction may become uncomfortable.
• In rare cases people can develop tinnitus after the treatment. People with existing significant tinnitus which worsens with noise or ears sensitive to sound should avoid wax removal techniques, which generate noise (e.g. syringing or suction).

The complications above can on rare occasions cause psychological and emotional distress.

Occasionally the earwax cannot be removed. This may occur if the ear canal is completely full of hard wax. It may be necessary for the earwax to be softened with eardrops and a further attempt made at clearing the wax at a different time.

MY EAR PROBLEM IS STILL THERE AFTER THE EARWAX WAS REMOVED. WHAT SHOULD I DO?

Some people may have another reason besides earwax causing the sensation blockage in their ear. This can be due to problems behind the eardrum in the middle ear such as fluid or glue ear. Sometimes the inner ear or hearing nerve is not working properly. This will require further assessment. You will need to see your GP to have this assessed further.

HOW OFTEN DO I NEED TO HAVE MY EARS CLEANED?

As mentioned previously most people’s ears are self-cleaning. It is not necessary to have the ear cleaned at a fixed timed interval since each person’s ears will require different intervals. The ear can be cleared if the ear blocks with earwax again. 

WHAT HAPPENS IF I DO NOT HAVE MY EARS CLEANED?

If the earwax is not causing any problems then no harm will come if the earwax is left alone. If earwax is causing problems such as blockage or hearing loss then the problem may persist if the earwax is not removed. Occasionally even if the earwax is causing problems, if left alone the earwax will migrate out and the problem improves without any treatment.

If you have any further questions or concerns, please contact our ear care professional at MY Hearing Clinic on 0191 917 8887 or email info@myhearingclinic.uk