Embarrassing Illnesses

In the majority of cases, earwax falls out on its own without the need to remove it. However, if earwax is totally blocking your ear, or if any of the following symptoms are present, it may need to be removed:

• hearing loss,
• earache,
• tinnitus (noises in your ear that come from an internal source),
• vertigo (the feeling that you are moving while you are still), or
• a cough.

Sometimes, earwax may also need 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 to remove an earwax plug usually starts with eardrops to soften the plug. If eardrops do not work, a process known as irrigation may be needed.

Eardrops

Your GP or a specialist may prescribe eardrops to soften your earwax so that it is easier to remove.
 
Eardrops 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 allows the eardrops to soak into the wax and soften it. If you repeat this two to three times a day for three to five days, the plug should eventually soften and may gradually fall out of your ear, bit by bit.

Eardrops are not suitable if you have a perforated eardrum.

Ear irrigation

Ear irrigation may be recommended if the earwax blockage persists, even after using eardrops.

Ear irrigation involves using a pressurised flow of water to remove the build-up of earwax. Nowadays, an electronic ear irrigator should always be used rather than a metal syringe, 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 is squirted into your ear canal to 'clean' out the earwax. The water is about the same temperature as your body.

The healthcare professional treating you may hold your ear at different angles in order to straighten your ear canal, which ensures that the water reaches all areas. They may also look inside your ear a number of times using an auriscope (an instrument for examining the inside of the ear) to check whether the wax is coming out.

The irrigation procedure is painless, but you are likely to feel a strange sensation in your ear as the water is squirted around your ear canal. Inform the person who is irrigating your ear if you have the following symptoms at any time:

• pain,
• inflammation (swelling) of the external auditory meatus (tube running from the outer ear to the middle ear),
• dizziness,
• vertigo (the sensation of movement while still),
• discharge from the ear, or
• hearing loss.

These symptoms may be caused by infection, and will need further examination.

Further treatment

If irrigation proves unsuccessful at removing the earwax, your GP may recommend one of the following:

• using eardrops again and returning for another irrigation,
• placing water into the ear before irrigating again after 15 minutes, or
• you may be referred to an ear, nose and throat (ENT) specialist to remove the earwax.

When not to use ear irrigation

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

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

Ear irrigation is not recommended if you have a grommet because the grommet creates a passage in your middle ear, allowing water to enter during syringing.

Grommets come out naturally, and the passage created by the grommet eventually heals. If your grommet has come out naturally, and you have been discharged by the ear, nose and throat (ENT) department, the passage will have healed, which means that you can have your ear syringed.

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 deafness.

Young children who are uncooperative, and some people with learning difficulties, may not be suitable for ear irrigation.

If you have a history of outer ear infections (otitis externa) or tinnitus (noises in your ear that come from an internal source), ear irrigation may aggravate your symptoms.

Other treatments for removing earwax

If your earwax cannot be removed with eardrops and/or ear irrigation, or if you are unsuitable for these treatments, a number of other treatment options may be considered. These include:

• microsuction: a noisy and possibly uncomfortable technique that uses a gentle level of suction under a microscope, or
• aural toilet: under direct vision, the specialist uses an instrument known as a Jobson Horne probe to manually remove the earwax.

Although there is no clinical evidence to show the effectiveness of mechanical methods of removing earwax (apart from irrigation), many ear, nose and throat (ENT) specialists regard microsuction as a routine treatment method.

Ear candling

Ear candling is not recommended as a method of removing earwax. Ear candling involves burning a hollow candle with one end in the ear canal. This creates a negative pressure, which draws earwax out of the ear canal.

Clinical studies have shown that ear candling is not an effective method of removing earwax. Never attempt to remove earwax yourself at home.