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All About Ear Wax Removal

What is ear wax?

Ear wax is made up of 3 parts, Dead skin cells, fatty acids and squalene (oil and sweat) and cholesterol.

Why do we produce ear wax?

To protect and lubricate our ear canals.

To fight infections as ear wax is mildly acidic.

To trap dust, dirt and foreign bodies.

What does impacted ear wax mean?

Impacted means the wax has been pushed further towards the end of the canal, usually around the bony end of the canal (which is usually more sensitive) or against the tympanic membrane itself. (The ear drum).

What does occluded ear wax mean?

This means there is a substantial amount of wax obscuring/blocking the view of the ear drum.

Symptoms of ear wax build-up

Ear wax build up should be removed ideally by a registered health professional. If left alone, a build up of wax could lead to reduced hearing, ear-ache or discomfort, loss of balance, tinnitus, hearing aid inefficiency and an increased likelihood of ear infections.

Who is more at risk of ear wax buildup?

The elderly (due to reduced production of sebum i.e. the skin's own lubricant.) Dryer skin occurs more frequently as the sebaceous and ceruminous glands lose their secretory ability. Ear wax buildup can sometimes happen due to a decline in self care as the build up of wax is left unaddressed for lengths of time.

There is debate about hearing aid users being more at risk of ear wax buildup. There is the question of whether one notices the buildup of wax more, because it affects the hearing aid performance or whether the hearing aid itself blocking the exit of the canal obstructs the ear wax from making it’s way out of the canal.

Skin conditions e.g. psoriasis, eczema can predispose one to produce more ear wax.

Dusty job environments could make the ear-canal potentially secrete more sebum as it tries to clear itself of the dust.

Narrow or hairy ear canals (more common in men) is likely to trap the wax within, or may hamper wax migration out of the canal.

Bony growths or protrusions within the ear canal restricts the migration of wax out of the ear.

High sugar and high fat diets where more wax is produced as the body tries to excrete more byproducts from foods.

Repeated ear-infections leads to ear wax build up as a result of built up debris often the result of accumulated drops and residues from the infection.

At Sonant Hearing Clinic we can help you in all these cases to clear your ears of wax build-up. You can call us on 01634 479550 to arrange an appointment to remove built up ear wax.

Methods of Ear Wax removal

Ear drops

In the UK, Olive oil ear drops are often recommended by audiologists, pharmacists and GPs. This is simply because it is safe and natural. It generally softens the wax in a similar fashion to natural sebum. However, sometimes, ear drops used alone may not be enough to remove the wax without the patient waiting significant lengths of time. Softening ear drops are still useful for "priming" significant amounts of wax ready for removal. This makes the ear-wax removal process less uncomfortable for the patient and easier for the hearing care professional to remove. Sodium bicarbonate is another option sometimes recommended although not often the first choice due to it's ability to potentially dry out the skin within the ear canal.

Instrumentation

Special tools made from plastic, carbon filled nylon, metal or stainless steel can be used to remove the wax (usually dry firm wax) such as curettes, loops, hooks and ear scoops. If successful the method is usually quick. The consistency of the wax can be the deciding factor for the best tool. Curettes are ideal for medium to softer textures of wax and forceps and hooks may be better for dryer consistencies of wax. The depth of the wax needs to be considered when selecting the best manual tool to use.

Micro suction

Involves the use of a suction tube which is connected to a pressure pump and waste collection canister. The Pressure pump delivers low gentle pressure through the suction tube to help safely remove the wax from within the ear. The hearing care professional usually observes the process through either a microscope, a lit up and magnified lens on a headlamp/pair of glasses or a magnifying camera connected to an endoscope on a phone-like device. Micro suction is presently the most popular method at present and preferred by most audiologists and ENT specialists in the UK because it can be used in ears with histories of perforations and mastoidectomies (provided they have been discharged from ENT). There is no risk of water-borne infection. The suctioning process can be continually observed during suction of wax. Cons are that some may consider the noise from the pump fairly noisy.

Irrigation

Generally suitable for standard cases of wax buildup with no history of perforations, grommets, or infections. The setup can range from basic setups with a bulb or metal syringe and a plunger to sophisticated setups which can monitor the water temperature and light up the ear canal allowing greater visibility. Irrigation allows water to be introduced into the canal in order to dislodge the ear wax out of the canal. An emesis (waste) basin is needed to collect the water coming out of the ear. Cons with this method includes the risk of dizziness if the water temperature is not close enough to body temperature.

Syringing

A procedure involving the use of water to flush the wax out of the ear. This practice has been stopped in most places since NICE stopped recommending the procedure.

Hopi Candles

This method is not recommended by registered hearing health professionals. There is a risk of burns, ear – perforations and ear-infections. It is dangerous and ineffective.

Hygiene

With wax removal, it is crucial that high standards of hygiene are adhered to. The right personal barrier should be worn (i.e. gloves, eye protection or masks if applicable). Hands need to be washed before and after contact for wax removal. Critical instruments must be sterilised and disposable instruments and infectious waste should be disposed after use appropriately.