Cerumen, otherwise known as earwax, is naturally secreted from glands in the outer third of the ear canal. The substances are secreted from the sebaceous and ceruminous glands. Normally, the earwax moves its way along the ear canal by way of new skin growth (known as the migration process). Along this process, the earwax can attract skin particles, hair from the ear canal and dust from within the atmosphere, forming cerumen (earwax) as we know it.
There are many reasons for this. If the skin of the ear canal is not migrating as it should, the ear canal can become blocked with earwax. The inappropriate use of cotton buds, or regular wearing of hearing aids, ear plugs, and ear buds can push and impact the earwax. Hair within the ear canal can become entangled with the earwax and stop its migration. Also, the glands that produce the earwax can be overactive and produce too much earwax.
There are some common symptoms if earwax is left to build-up and become impacted, such as earache and having a sensation that the ear is generally blocked. Other symptoms can include:
Conductive hearing loss: earwax restricts sound waves from travelling efficiently through the ear canal and vibrating against the eardrum.
Occlusion: internal sounds such as chewing, breathing, heartbeat and your own voice can no longer escape out of the ear and are therefore heard much louder inside your head.
Tinnitus: a ringing/whistling/buzzing type of sound that originates from inside your ear and only be heard by yourself.
Vertigo or dizziness: an increase in air pressure due to the wax inside the ear canal can inadvertently stimulate the organ of balance which is located inside the inner ear.
Coughing: like vertigo, an increase in air pressure due to the wax inside the ear canal can inadvertently stimulate the facial nerve located inside the middle ear.
Whistling of hearing aid: sounds being amplified by the hearing aid are reflected back out of the ear due to the wax causing acoustic feedback (e.g. whistling) of the hearing aid.
Itchiness/irritation: wax that is impacted, especially dry wax, will rub against the side of the ear canal upon any jaw movements.
Traditional ‘syringing’ was a widely used method in which a syringe filled with water was used to flush earwax away. This method is no longer recommended under NICE (National Institute for Health and Care Excellence) guidelines due to the risks of a perforated eardrum.
Water irrigation (sometimes incorrectly referred to as ‘syringing’) uses warm water to wash earwax out of the ears after the prolonged use of earwax softening ear drops, such as olive oil. This method is performed ‘blindly’, with no view of the ear canal itself. This procedure is not suitable for those with previously perforated eardrums. It was the preferred method used in GP surgeries for many years. You might find that most GP surgeries have now stopped offering this as a service.
Microsuction is a safe and gentle method of removing excess earwax from the ear canals. Using a head worn optics system (often called loupes), the earwax removal professional can visualise the ear canal and proceed to gently remove the earwax blockage with a fine, sterile probe which is attached to a low-pressure vacuum pump. At Apex Hearing Health we use the highly regarded Vorotek O Scope convergent optics system to clearly visualise the ears, ear canal and eardrum.
According to studies, the microsuction method of removing earwax is certainly considered to be safer and more effective compared to water irrigation (sometimes, but incorrectly known as syringing), as it avoids touching the sensitive skin of the ear canal and will have no contact with the ear drum.
Although not entirely necessary for a soft earwax blockage, we do recommend that a clinically treated oil such as Earol® is used for at least 2 days before the appointment for hard, impacted earwax. 1-2 drops, twice a day for 2 days prior to the appointment will be fine. The oil will help to lubricate the ear canal and will soften the wax to make it easier for the suction probe to extract. Earol®, CleanEars® and other clinically treated oils are available to buy from pharmacies, supermarkets and on-line retailers.
There are numerous drops or sprays widely available from pharmacies, supermarkets or online retailers to aid in the softening of earwax. Earol® and CleanEars® are two that I would personally highly recommend as, from experience, they tend to be gentle on the skin of the ear canal. Sodium Bicarbonate ear drops can be used sparingly (1-2 drops on the day before to the appointment) for hard, impacted earwax.
Disclaimer: I have no affiliation to any of the above-mentioned products and any comment about them is personal opinion from my experiences over the years.
This is my own opinion, but I would absolutely not recommend Otex® ear drops prior to any suction type earwax removal! Otex® and Otex Express® drops contain peroxide which can aggravate the sensitive skin of the ear canal and in some cases can cause pain. They also break earwax down so much; the earwax almost turns into a liquid. Great for water irrigation – not so good for suction.
You may not be suitable for vacuum suction (microsuction) if you are extremely sensitive to loud noise (Hyperacusis), have a history of severe dizziness. Microsuction is an excellent alternative to ear syringing and water irrigation, especially if you have ever suffered with ear infections, have had previous ear surgery or have any problem where you are advised to keep your ears dry.
Some people may have another reason besides earwax causing the sensation of a blockage in their ear. This can be due to problems behind the eardrum in the middle ear such as fluid or glue ear. Sometimes the inner ear or hearing nerve is not working properly. Or there is a eustachian tube dysfunction. We can offer advice, but there is a chance that these symptoms may require further assessment. You may then need to see your GP to have this assessed further. We can help support you by drafting a letter to your GP explaining our findings if required.
Most people’s ears clean themselves and it is not necessary to have them cleaned professionally. For people who experience a build-up of ear wax there is not fixed time period to have it removed. As a rule, ear wax should only be removed if you are experiencing problems or difficulties with it. Otherwise, it should be left alone.
Apex Hearing Health can offer annual ear examination appointments (recommended) to ensure your ears are in good health. This is like visiting an optician to have your eyes checked or a dentist to have your teeth inspected each year.