TREATMENTS

Ear Drops

Ear drops can be bought from the chemist over the counter and are the cheapest method of wax removal. Ear drops are commonly marketed as a cheap way of removing earwax at home. For an ordinary member of the public, the choice of different branded and unbranded products can be overwhelming.

Olive oil

Olive oil ear drops are the gentlest type. The olive oil softens the edges and outer surface of the wax and is well-tolerated by most people. Some more expensive versions have added menthol to produce a cooling sensation, or eucalyptus to give a pleasant smell.

• Pros: cheap; gentle; generally well-tolerated; can be used for extended periods
• Cons: can take a long time to work on its own; can make the ear feel bunged up,;added ingredients may not be so well-tolerated

Other Oil Blends

Some proprietary brands contain blends of light oils that soften ear wax.

• Pros: gentle; possibly faster acting than olive oil
• Cons: more expensive than olive oil; wax can sometimes dissolve and slide further down the ear canal, rather than coming out.

Sodium Bicarbonate

Sodium bicarbonate / bicarbonate of soda ear drops are alkaline, while ear wax is acidic. Therefore they work by chemically dissolving ear wax rather than softening it, and work much quicker than olive oil. They can be used for a day or two by most people without any problem.

• Pros: also cheap; tolerable for a day or two; quick
• Cons: wax can sometimes dissolve and slide further down the ear canal, rather than coming out; extended use can strip the protective lining of the ear canal and lead to infection.

Peroxide-Based

Some ear drops, including proprietary and chemist own-brand, are based on peroxide in some form, often urea peroxide. When compared to sodium bicarbonate drops, peroxide-based drops are similarly effective, but also effervesce.

• Pros: quick
• Cons: more expensive than sodium bicarbonate drops; wax can sometimes dissolve and slide further down the ear canal, rather than coming out; contain peroxide (bleach), and some individuals can experience a painful reaction even immediately after one application. For this reason we don’t recommend peroxide-based drops.

In general, ear drops can sometimes take weeks to work, and hearing will often get worse before it gets better. There is also the possibility that the wax will slide further down the ear canal, form one large lump, and completely block the ear. Ear drops are not recommended if you have a perforated eardrum.

Ear Sprays

Ear sprays can be water-based or oil-based. They usually incorporate a conical nozzle that is placed into the entrance of the ear canal and the spray is then applied.

Water-Based

Water-based ear wax removal sprays can be effective if the amount of wax blockage isn’t too great. They are often simple saline, or may be sterilised sea water.

• Pros: gentle; salt water based; well tolerated
• Cons: may push wax further into the ear by the force of water; water may get trapped behind wax and create a “head under water” feeling

Oil-Based

Oil-based ear wax removal sprays, such as EAROL, are great for softening wax prior to other procedures, and are very effective at penetrating wax due to their small droplet size.

• Pros: cheap; safe; penetrate wax better than drops; reach further into the ear because of spray; great preventative measure when used once a week
• Cons: may not remove wax on their own

Ear Syringing / Ear Irrigation

Ear irrigation is normally performed by a GP practice nurse, a district nurse, and by some Audiologists. Traditionally, a metal ear syringe was loaded with warm water, the metal tip placed into the ear canal. The water was then squirted into the ear canal and a kidney dish was held under the ear to catch the water and wax that was flushed out. The syringe would have to be regularly lubricated to allow a smooth level of pressure to be applied, and the nurse would use his or her judgement as to how forcefully to syringe the water. Syringing can’t shift hard wax, so it must be softened for up to two weeks before syringing is performed.

Nowadays, for safety reasons the metal ear syringe has been replaced by an ear irrigator pump with a jet tip. The pump has a variable, regulated pressure, but the process is essentially the same. Many people have had their ears syringed or irrigated many times without any issue arising. Here are the pros and cons of ear syringing:

• Pros: usually free on the NHS; when it works it works well
• Cons: cannot remove hard wax; can push wax further into the ear if the angle of the jet is slightly off; may cause tinnitus; may perforate the eardrum; an undiagnosed perforated ear drum may not be seen due to the amount of wax, causing water, bacteria, wax and dead skin cells to be flushed past the eardrum into the middle ear, potentially causing a painful infection; not recommended following ear surgery; should not be performed when the eardrum has previously been perforated due to the risk of re-perforation.

Due to the long list of potential complications listed above, many surgeries are withdrawing their ear syringing service, and are referring all patients to the NHS ENT clinic, which may have a long waiting list.

Dry Instrument Removal

Dry instrument ear wax removal is normally performed by an ENT surgeon or an Audiologist. The practitioner uses a selection of different shaped instruments called Jobson Horne probes or curettes. These are like miniature spoons and loops that are used to hook or scoop the wax from the ear canal. It is normally performed under illumination. There is a great choice for the practitioner of metal, or plastic disposable curettes, and some of them even have their own light built in. The practitioner will usually apply some Earol to loosen the wax from the ear canal wall before performing the procedure. The tip of the curette is normally pushed past the wax and the drawn back out, bringing the wax with it.

• Pros: quiet – so great for those who don’t like noise; quick – often the wax can be removed in one or two big lumps
• Cons: small possibility of pushing the wax deeper into the ear; hard wax may be uncomfortable to remove

Micro Suction Ear Wax Removal

Microsuction is by far the most effective method of earwax removal. Traditionally only performed in ENT clinics due to the size and weight of the equipment, it can now be performed by appropriately trained individuals in smaller clinics due to portable suction pumps and operating microscopes that are now available.

Micro suction is made up of two words: “Micro” refers to the operating microscopes that can either be large floor standing units, or can be incorporated into glasses, in which case they are known as operating loupes. “Suction” refers to the medical suction pump that is attached to a tube and a 2 millimetre suction wand, which is used to suction the wax from your ear.

Micro suction requires a good knowledge of the anatomy of the ear, along with training in how to safely use the equipment. For this reason, microsuction is performed by ENT surgeons and Audiologists, who both specialise in the ear, and by specialist nurses who have had further training.

Micro suction only removes wax from the ear – because it doesn’t spray water into the ear it is safe to use after ear surgery, or when the eardrum is perforated. The Micro Suction Practitioner uses a powerful operating microscope and a bright light source, so he or she can see exactly what is happening inside your ear, so the procedure is the safest of all.

• Pros: safest method; can be used after ear surgery; can be used where the eardrum is or has been perforated; painless; virtually no risk of infection; usually quick
• Cons: possible slight discomfort if wax hasn’t been pre-softened; can sometimes require a second visit (in the case of severely impacted wax); some people find it a little noisy (although clinical studies show that the noise levels are safe)

Conclusion

There are many methods of ear wax removal. The safest ear drops are olive oil, and the best are Earol spray (also made of olive oil). The best professional method of ear wax removal is micro suction, due to its high level of safety. It may cost slightly more than other methods, but it is worth it as, after all, you only have one pair of ears!