Removal of ear wax
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7354.27 (Published 06 July 2002) Cite this as: BMJ 2002;325:27
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The statistics are strange.
While complications occur with this as any procedure, I have syringed
more than 100 ears, and perforated less than 15 - in fact none. I do not
think this is unusual.
I suspect that dividing the number of ears syringed by the number of
complications would give a more instructive picture.
What is the incidence or the absolute risk per ear?
Competing interests:
None declared
Competing interests: No competing interests
many online journals quote Otitis Externa as one of the major
complications of ear syringing. But in has anyone in their ENT or GP
careers come across any example where a figure, of any sorts, is cited?
It is strange how a health problem of such magnitude that takes a
great proportion of clinic time in both GP and ENT clinics has not been
worthy of even one substantial randomized controlled trial.
If manual syringing, that takes place in most GP surgeries, is as
controversial as it is made out to be, what can replace this procedure?
Can we ask patients to use wax softeners like olive oil "until further
notice"? Are electric jet irrigators any different or better than manual
ones? Is there any evidence to support this?
And finally what has a priority- syringing to remove ear wax or the
treatment of resulting otitis externa?
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None declared
Competing interests: No competing interests
In my clinical practice, I have seen many patients claiming that they
had the problem of frequent collection of wax in the external ear canal
after they had been to have the wax remove, adding that thay did not have
such a problem before this first cleaning history!!. In such cases I
recommend them to use wax softeners such as glycerine for a few days in
each month. this might be better solution than the cotton buds.
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The article is quite useful. However, it left me with a couple of
questions. Which companies manufacture the oral jet irrigator with
special ear irrigator tip? What is the evidence that this is a safer
method? [Clinical Evidence did not comment on any trials comparing this to
other methods]
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I was taught that the reason for wax build up was the absence of
lateral movement of the lining of the ear canal.
We were told that a ink mark put on the tympanic membrane would with time
migrate outwards. Evidence to support this is the appearence of wax in the
outside of unwashed ears of young kids.
Cotton buds act only as a ram to push in the wax. It is quite common to
see the imprint of a cotton bud on impacted wax.
I quote the maxim "The biggest thing ypu put in your ear is your elbow" to
my patient.
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Irrigation of the ear canal can increase the ear pH, and so,
infection risk could increase. Acidifying the ear canal with acetic acid
(1%) after irrigation could be useful to decrease this complication. I
think this knowledge should be included in the article.
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Cotton buds! Are they not a menace? Why do we not demand that the
manufacturers add a warning not to use in ears? They once advertised them
for use 'in baby's little places. There were effective protests!
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Re Ear Syringing, there appears to be no mention of the need to expel
all air from the syringe. The experience of having any residual air forced
against the ear drum, without warning, is painful and disconcerting, to
say the least.
A. Kuchel,
South Australia,
Australia.
Competing interests: No competing interests
Cotton buds ("Q-Tips" on this side of the Atlantic) are absolutely
unnecessary for ear cleaning. As I point out to my patients, Mother Nature
took care of ear cleaning for thousands of years before Q-Tips were
invented.
The ears naturally clear cerumen and, in the vast majority of cases,
usual bathing is sufficient.
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Ear wax blockages and stalagmites
It was probably in my late thirties that I first noticed pain in one of my ears.
I assumed that it was probably one of those symptoms which would subside within a few days without treatment, but it persisted, and became gradually worse until it was intolerable.
I also considered the possibility that if I didn’t do something about it that it may lead to ear damage and deafness, so I consulted a doctor.
He examined my ear with an otoscope and said that he could see that a lump of ear wax was blocking the ear canal and that he would try to remove it.
He then placed a towel on my shoulder and filled a small kidney bowl with warm water and placed it close to my neck and under my ear.
He then filled an ear syringe with some of the water and put it’s tip into the opening of my ear and then began pushing the plunger to gently force the water into the outer auditory canal, and then withdrew the plunger to suck the water out again.
As he did that repeatedly I could hear the swishing and swirling sound of the water gushing in and out very clearly but it didn’t relieve the pain.
However he was able to extract some small pieces of ear wax which he emptied into the kidney bowl.
He then filled the syringe with clean water and repeated the process about six times.
During that procedure he told me that if he couldn’t remove the wax blockage he would give me some ear drops to use to gradually dissolve the wax and that I could return to have it removed later.
He was about to give up and provide me with the ear drops when he tried one more time and a few moments later I felt an immediate relief of the pain.
He said that the wax lump had came out into the syringe and had been ejected into the kidney bowl, and then he showed it to me.
It was an uneven shape perhaps three or more millimetres in total circumference.
He then syringed my ear again several times to clear out any other loose wax debris until the water was clear.
I asked him what caused the problem and he said he didn’t know.
I suppose another ten years went by when I began to feel a sense of pressure in one of my ears, and as the weeks went by it became more and more noticeable, and somewhat uncomfortable and annoying, so I began to drag on my ear lobe in an attempt to open my ear canal wider and clear it, and it was sometimes effective.
However I eventually experienced a reduction in my hearing from that ear, and I noticed that if someone was talking to me from one side I could hear them clearly, but if they were on the other side my hearing was muffled.
That problem persisted and was no longer responding to my attempts to clear the ear canal, so I consulted a doctor again.
He inspected my ear with an otoscope and said that the outer ear canal was blocked, so he arranged for a nurse to remove it by the same method which had been used a decade earlier.
The same process of gently plunging warm water into and out of my ear canal was applied and reapplied until I noticed an immediate ability to hear clearly again, and the nurse said that she had just ejected a lump of wax into the kidney bowl to show me.
She also re-syringed the ear several times to clear any remaining debris, and applied the same method to the other ear, but only small amounts of wax were found.
When I asked her if she knew the cause she said she didn’t, so I became curious about why it should affect me and not other individuals, and whether or not it would happen again.
I was told that it was a common problem of unknown cause.
Several more years went by when I had the same problem of discomfort and muffled hearing, and went through the process of having the wax extracted again, so, although it wasn’t a serious problem, I became even more curious about the cause for the purpose of developing a way of preventing a recurrence.
One day I had just had a shower, and a few minutes later felt some mild discomfort in my ear so I placed my small finger tip against the outer indentation of the ear canal and noticed that it was occupied by a quantity of water of perhaps two or three drops, and because of it’s location I could hear the squishing sound as I gently pressed on it.
I then considered the possibility that the soap or hair shampoo which I had been using previously while showering may have been getting into my ear, and staying there, instead of running outwards, and that the soap was dissolving very small amounts of wax each time, so that it drained through the ear canal to became deposited as an accumulating lump.
I then compared it to the way in which small amounts of water drain from the top of lime stone caves to gradually form stalactites or stalagmites over a period of years, decades, or centuries.
By comparison, the amount of wax being dissolved by three drops of soapy water during two showers a day, or 730 times a year, for several years, may be what causes the gradual build up of a wax lump in the ear until it was large enough to cause the blockage.
I don’t know if it will make any difference, but I now minimise the exposure of my ears to soapy water when having a shower, and check them after each shower, and if there is any moisture present I gently remove it by softly touching the area with a towel to absorb it.
I consider it to be worth trying because it is easy, and won’t do any harm, and might solve the problem.
Competing interests: No competing interests