Ear wax is a waxy material produced by sebaceous glands inside the ear.  It cleans, lubricates and protects the lining of the ear by trapping dirt and repelling water.  Ear wax is slightly acidic and has antibacterial properties.  Without ear wax, the skin inside your ear would become dry, cracked, infected or waterlogged and sore.  It is extremely important to remember that due to its protective properties, a thin layer of wax left on the lining of the ear canal, following procedures such as syringing and microsuction, is extremely beneficial.  The aim of ear wax treatment is not to completely eliminate ear wax.

Ear wax can be wet or dry, hard or soft. Soft ear wax is more common in children and hard ear wax is more likely to cause problems.  Everyone makes ear wax but the amount and type are genetically determined just like hair color or height.  Some people have ear canals that are smaller than average or shaped in a way that makes it difficult for the naturally occurring wax to get out of the canal, causing wax impactions.  Some people produce more ear wax than others. It usually falls out of your ear gradually, in small pieces or flakes. Sometimes, ear wax can build up and harden, creating a blockage called a “plug”.  As well as causing discomfort, an ear wax plug can also cause temporary hearing loss because it blocks your ear canal. Once the blockage is removed, your hearing will improve.
Some people are naturally more susceptible to developing a blockage in their ear, for various reasons.  Blockage, or impaction, also occurs when the wax gets pushed deep within the ear canal.  Ear wax  blockage affects about 6% of people and is one of the most common ear problems doctors see.  Your risk of developing problems from a build-up of ear wax 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 – these are called osteomata
  • a skin condition of your scalp or preauricular area
  • hard wax
  • a history of recurrent impacted earwax
  • repeated ear infections
Elderly people are more at risk of having ear wax problems because ear wax becomes drier with age.  Your chances of developing an earwax blockage are also increased if you:
  • Use cotton buds – they can push ear wax deeper into your ear and pack it together harder, creating an ear wax plug
  • Wear a hearing aid or earplugs, which can stop ear wax falling out of your ear naturally
Ear wax doesn’t usually cause problems, but a build-up of ear wax can lead to a blocked ear or fullness sensation, ear pain/discomfort and hearing loss.  Too much ear wax can also cause other symptoms, including:
  • Ringing in the ear
  • Itching or drainage from the ear canal
  • Vertigo or Dizziness
Treating ear wax build-up In most cases, ear wax falls out on its own, so there’s no need to remove it. However, if it’s completely blocking your ear canal and causing hearing loss or discomfort, it may need to be removed.  Indications for earwax removal include:
  • Difficulty in examining the full tympanic membrane (ear drum)
  • Otitis externa – external ear canal infection
  • Wax occlusion of the external ear canal
  • As part of the workup for conductive hearing loss
  • Prior to taking the impression for hearing aid fitting
  • Suspected external ear canal or middle ear cholesteatoma
  • As part of grommet insertion or middle ear surgery
  • Patient request

Ear Microsuction Ear Microsuction is where a special suction device is used to remove the ear wax under a microscope or a special light loupe with magnification. The procedure is quick, safe and painless.  This technique will soon be offered by the Earicare as it is the safest and most efficient method of removing ear wax.

Aural Toilet Aural Toilet treatment uses an instrument called a Jobson Horne probe. A Jobson Horne probe is a thin metal or plastic instrument with a small ring at one end that the specialist can use to remove earwax from your ear canal.  We sometimes have to use instruments like this in order to gently help wax come out.

Ear drops for Ear Wax Removal Ear drops can be used to soften and loosen the ear wax.  Ear drops should not be used if you have a perforated eardrum.  Ear drops vary in composition from olive oil, to sodium bicarbonate to hydrogen peroxide based drops available in many pharmacies.  Olive oil is generally completely harmless but sodium bicarbonate and hydrogen peroxide based drops can be quite irritant to the ear canal so must not be used for prolonged periods.

Ear Irrigation An electronic ear irrigator is used; it involves a pressurised flow of warm water that removes the build-up of earwax. The irrigator has variable pressure control so that irrigation can be performed at the minimum pressure. A controlled flow of warm water will be squirted into your ear canal to flush out the earwax. Ear irrigation should never cause pain. Preparation of wax with olive oil ear drops may not be necessary, clinician with decide whether or not olive oil ear drops is necessary.

Irrigation should NOT be carried out if:

  • Had previously experienced complications following this procedure in the past
  • There is a history of a middle ear infection in the last six weeks
  • Have undergone ANY form of ear surgery (apart from grommets that have extruded at least 18 months previously and it is documented subsequently that the tympanic membrane is intact)
  • You have a perforation
  • There is a history of a mucous discharge in the past twelve months
  • There is evidence of acute otitis externa with pain and tenderness of the pinna
  • There is a history of cleft palate, repaired or not

Your ears are designed to be self-cleaning and will normally produce enough earwax to prevent problems occurring, and make its way out of the ear, completely on its own.

Many people use cotton buds in an effort to ‘clean’ their ears from excess wax, but you’re actually more likely to cause earwax blockage and further issues. Rather than removing the earwax, it instead pushes it further into the ear, which leads to a build-up, or impacted wax.

If not removed, impacted earwax can lead to infection, which will need to be treated by a doctor.

Hearing loss is the most obvious sign that you may need to have wax removed from your ear. There are a few other slow-growing signs that you can look out for, especially if you have a history of compacted earwax.
  • Ear pain - Usually resulting purely from pressure on the ear canal, if the wax has been pushed deep into the ear, the pain may come from direct pressure on the eardrum as well.
  • Cough - This is actually caused by the hard wax pressing a nerve called the vagus nerve which runs along the ear. The pressure can excite the nerve and make you cough despite your throat being clear.
  • A ‘full’ ear - If the hard wax is pressing equally around the ear canal, then it is experienced as a sensation of fullness inside the ear.
  • Your ears are self-cleaning so you should be fine to just leave them to it. If you feel earwax is causing a problem, get in touch with EariCare to discuss treatment options.

Microsuction is a technique for removing ear wax or debris using either an ENT (Ear Nose and Throat) binocular operating microscope or specialised magnification loupes (similar to the type dentists use).

This allows the clinician to look in the ear canal in great detail and use a very fine sterile suction device at low pressure to remove the wax. 

This process is not dissimilar to using a tiny vacuum cleaner inside the ear to remove the wax.  Occasionally we may need to use other instruments to remove hard wax (such as Jobson Horne probes or micro forceps).

Using microsuction means that we can visualise the external ear canal and its contents in great detail while having minimal physical contact with the earlobe. This makes the process more comfortable for patients. Preparation of wax with olive oil ear drops is not usually necessary but may make the procedure faster and more comfortable for the patient.

Our Weekly clinic at Clover Health Centre in Woolwich is easily accessible from London through multiple transport routes.