Ear Wax Management - The case for microsuction ear wax removal
Updated: Nov 22
Earwax, a self-cleaning agent, protects the outer ear. Sometimes this does not work and wax gets impacted, blocking the ear canal. This is a major reason for primary care consultation. Hearing difficulty due to untreated wax impaction can lead to social isolation and depression. Further, people find it difficult to access NHS earwax services.
Read the original article here: https://bjgp.org/content/73/727/90
WHY DOES Ear Wax Removal MATTER?
Earwax build-up occurs in anyone but often in older people and those using hearing aids or earbud earphones. Up to 44% of care home residents with dementia also have impacted earwax and about 2.3 million people/year in the UK have troublesome earwax requiring removal.
Studies investigating ear wax removal methods report how much of the tympanic membrane is visualised before and after treatment, but this does not capture the impact of the symptoms. This article reports on a symptom survey completed by 489 patients who attended the Trafford Ear Care Service, Manchester, during 2022. The most common symptom was hearing difficulty (86.5%; 423) with half of those with hearing difficulty reporting additional symptoms, including discomfort, tinnitus, or change in quality of their voice. Before wax removal, the most bothersome symptom was reported to be hearing difficulty (78.3%; 383), impacting on communication, focused listening (for example, TV), and awareness of surroundings.
Predicting the effect of impacted wax on an individual is difficult as it depends on the quantity, consistency, and location of the wax within the ear canal.
WHY THE CURRENT CONTROVERSY?
The National Institute for Health and Care Excellence (NICE) recommends that earwax removal services should be available in primary care.1 However, earwax services are so scarce and non-existent in some locations that user groups led by the Royal National Institute for Deaf People campaign for wider access in primary care.
With long delays on the NHS patients are seeking out secondary care elsewhere. A Healthwatch Oxfordshire survey revealed that adults with earwax required 1–4 NHS visits prior to attending a dewaxing clinic, that time from symptoms to resolution was 3–30 weeks, and that microsuction required additional visits and longer waits.
But there’s no need to wait! Here at Earful you can book an appointment online and some clinics even have walk in availability.
WHICH PRE-TREATMENT EARWAX SOFTENER IS BEST?
Pre-treatment drops or sprays soften the impacted wax making it easier for removal. A current concern is that earwax is often untreated with the mistaken belief that self-management with pre-treatment softeners is sufficient.
NICE recommends pre-treatment softeners for up to 5 days before removal but stop short of recommending any particular product.
Here at Earful we recommend softening your earwax with simple medical grade olive oil.
WHAT PROCEDURES ARE RECOMMENDED FOR EARWAX REMOVAL AND WHAT DO PATIENTS PREFER?
NICE recommends electronic water irrigation and microsuction for earwax removal (or an alternative such as manual removal). National training courses on wax removal for registered healthcare professionals (nurses, healthcare assistants) are available, with a requirement for an update every 3 years.
Manual water-filled syringes are no longer recommended in the UK because of potential damage to hearing and risk of litigation. Electronic devices that control the flow of low pressured water to flush the earwax from the ear canal are now in use.
There are anecdotal reports that drying the external ear after irrigation reduces the risk of ear infection.
The alternative is to remove wax under direct visualisation using mechanical suction, the method of choice in secondary care. Lower-cost, portable hand-held video-assisted systems providing magnification and illuminated visualisation of the ear canal are a potential solution for widescale use.
In the service evaluation mentioned above, all patients were offered both treatments and more than two-thirds had no or only a small preference for either irrigation or microsuction. The proportion with direct experience of both procedures is unknown, but those expressing a preference for irrigation sometimes reported that previous microsuction was painful or noisy whereas those preferring suction report it is less messy compared with irrigation. There is currently no high-quality evidence comparing professionally administered and home-based procedures.
Alternative methods of treating earwax such as ear candles are not recommended because these are ineffective. Also, inserting cotton buds into the ear canal has the potential to damage the ear and cause wax impaction.
· A significant number of people fail to get the care they need for earwax removal when there is an urgent need.
· Pre-treatment softeners are recommended followed by removal using microsuction.