Ear Irrigation / Syringing

Simply Ears

Introduction

 Earwax is a waxy material that is produced by sebaceous glands inside the ear. It cleans, lubricates and protects the lining of the ear by trapping dirt and repelling water. 

Earwax is slightly acidic and has antibacterial properties. Without earwax, the skin inside your ear would become dry, cracked, infected or waterlogged and sore. 

Earwax can be wet or dry and hard or soft. Soft earwax is more common in children and hard earwax is more likely to cause problems.

 What is earwax made from? 

Earwax is made up of different substances that help stop the skin that lines your ear canal from drying and cracking. Earwax contains: 

  • desquamated keratin squames: dead, flattened cells on the outer layer of skin
  • cerumen: a wax-like substance produced by sweat glands
  • sebum: an oily substance produced by the sebaceous glands (glands in the skin) 
  • various other substances: such as cosmetics and dirt

 Earwax problems 

Earwax doesn’t usually cause problems. However, producing too much earwax can lead to a blocked and painful ear or hearing loss.

 When to see your GP

 Ask to see the nurse or GP at your GP surgery if you’re having problems with earwax. Don’t attempt to remove the earwax yourself without first speaking to a healthcare professional. 

Your practice nurse, GP or a hearing specialist may examine the inside of your ears using an instrument called an auriscope. An auriscope, also known as an otoscope, has a light and a magnifier at one end to allow the inside of your ear to be clearly seen. 

During the examination, your doctor will see if there’s a build-up of earwax and whether it’s impacted (firmly lodged in your ear canal). If you have hearing loss, it may be due to impacted earwax. 

Causes 

People who produce a lot of earwax are more likely to develop a blockage in their ear than those who only produce a small amount. 

Who’s at risk? 

Your risk of developing problems due to a build-up of earwax is increased if you have: 

  • narrow ear canals or ear canals that aren’t fully formed
  • a lot of hair in your ear canals
  • bony growths in the outer part of your ear canal (osteomata)
  • a skin condition of your scalp or preauricular area (the area just in front of your earlobe)
  • hard wax, because it’s more likely to become impacted (firmly lodged in your ear canal)  
  • a history of recurrent impacted earwax
  • repeated ear infections.
  • learning difficulties (the reason for this is unknown) 
  • use cotton buds: they can push earwax deeper into your ear and pack it harder together, which creates an earwax plug
  • wear a hearing aid or earplugs, they can stop earwax falling out of your ear naturally.
  • Elderly people are also more at risk of having earwax problems, because earwax becomes drier with age.  

Treatment 

In most cases, earwax falls out on its own and there is no need to remove it. However, if earwax is completely blocking your ear canal and causing hearing loss, it may need removing. 

Earwax also sometimes needs to be removed to make an impression of the ear canal for a hearing aid mould, or if the earwax is causing the hearing aid to whistle. 

Treatment usually starts with ear drops to soften the earwax. However, if ear drops do not work, a process called ear irrigation may be needed. 

Ear drops 

Ear drops, available from your pharmacy, can be used to soften and loosen the earwax, which may help it to work its way out naturally. Speak to your pharmacist about which ear drops are suitable for you. 

Ear drops should only be used when they are at room temperature. Pour a few drops into the affected ear and lie on your side for a few minutes with the affected ear facing upwards. 

This will allow the eardrops to soak into the wax and soften it. Repeating this two or three times a day for at least five days will cause the plug to soften. It may then gradually fall out of your ear bit by bit. olive oil drops are usually recommended.                                       

 Ear drops should not be used if you have a perforated eardrum.

 Ear irrigation

Ear irrigation may be recommended if your earwax blockage persists, even after using ear drops. It involves using a pressurised flow of water to remove the build-up of earwax. 

An electronic ear irrigator is used, rather than a metal syringe as happened in the past, to avoid damaging the ear. The irrigator has a variable pressure control so that syringing can begin at the minimum pressure. 

During the procedure, a controlled flow of water will be squirted into your ear canal to clean out the earwax. The water is a similar temperature to your body. 

While irrigating your ear, the healthcare professional treating you may hold your ear at different angles to ensure that the water reaches all of your ear canal. 

They may also look inside your ear several times using an auriscope (an instrument designed to examine the inside of the ear) to check whether the wax is coming out. 

Ear irrigation is usually a painless procedure, but your ear may feel strange as the water is squirted around your ear canal. 

Tell the person who is treating you if you have any: 

  • pain
  • dizziness
  • vertigo: the sensation of movement when still
  • hearing loss  

Symptoms such as these may be the result of an  ear infection and will need further investigation. 

If ear irrigation is unsuccessful at removing earwax from your ear, your practitioner may recommend: 

  • using ear drops again and returning for another irrigation
  • that you be referred to an ear, nose and throat (ENT) specialist to remove the earwax 

When ear irrigation is not recommended 

Ear irrigation is not suitable for everyone. It should not be used if you have: 

  • previously had problems with irrigation, such as pain in your ear or severe vertigo
  • a perforated eardrum, or you have had a perforated eardrum in the last 12 months
  • a discharge of mucus from your ear, which may indicate an undiagnosed perforation
  • had a middle ear infection in the past six weeks 
  • a grommet (a small, hollow tube that is surgically inserted into your ear if you have a build-up of fluid that causes hearing difficulties – see below)
  • had ear surgery, apart from cases of extruded grommets, within the last 18 months
  • a cleft palate (whether repaired or not)
  • a foreign body in your ear
  • a severe external ear infection with pain in the ear canal or pinna (the visible part of your ear) 

Ear irrigation is not recommended if you have a grommet. The grommet creates a passage in your middle ear which allows water to enter during syringing.

Grommets come out naturally, and the passage created by the grommet should eventually heal. Once the passage has healed, you can have your ear irrigated. 

You should not have ear irrigation if the ear to be treated is your only hearing ear. This is because there is a very small chance that it could cause permanent hearing loss. 

Young children who are un-cooperative, and some people with learning difficulties, may also not be able to have ear irrigation. 

Other treatments 

If your earwax cannot be removed using ear drops and ear irrigation, or if you are unsuitable for these treatments, alternative options may be considered. These include: 

  • microsuction: where a special suction device is used to remove the earwax under a microscope. The procedure is quick, safe and painless, and it doesn’t involve putting liquid into your ear.
  • aural toilet:  where an instrument called a Jobson Horne probe is used. A Jobson Horne probe is a thin metal instrument with a small ring at one end that the specialist can use to remove earwax from your ear canal.  

Complications 

There are several complications that can occur as a result of impacted earwax or ear irrigation. 

An ear infection may develop if you have untreated impacted earwax (earwax that is firmly lodged in your ear canal). 

If your earwax touches your eardrum (tympanic membrane), it may cause discomfort and vertigo (the sensation that you are moving even though you are still). 

The following complications have been reported from patients after their ear irrigation: 

  • middle ear infection (otitis media)
  • infection of the external ear canal (otitis externa)
  •  perforated ear drum
  • damage to the external auditory meatus (the tube that connects the outer ear to the middle ear)
  • ear pain
  • vertigo
  • worsening of pre-existing tinnitus (the perception of noises in your ear that come from inside the body) 

Sometimes, light bleeding can also occur which usually stops on its own. Nausea, vomiting and vertigo may occur due to variations in the temperature of the irrigating fluid. 

Rarely (in about 1 in every 1,000 ears that are irrigated) serious complications can occur. These are described below. 

Severe infection 

In rare cases, infection may progress to the base of the skull and cause cranial paralysis, meningitis (infection of the protective membranes that surround the brain) and even death. 

The elderly, people with diabetes and those with a weak immune system are most likely to be affected.

 Chronic tinnitus 

Long-term (chronic) tinnitus can sometimes occur following earwax removal or ear irrigation. However, this is rare. 

Prevention

 To reduce the risk of developing problems with your ears, avoid putting objects in your ears, such as cotton buds, matchsticks or hair pins. 

Putting objects in your ears can:

  • damage the wall of your ear canal, which increases your chances of developing otitis externa (inflammation of the ear canal),
  • cause the wax to become impacted (firmly lodged in your ear canal) by pushing it further into the canal, and
  • perforate (puncture) your eardrum.