Intended for healthcare professionals

Practice 10-Minute Consultation

Aural microsuction

BMJ 2017; 357 doi: (Published 29 June 2017) Cite this as: BMJ 2017;357:j2908
  1. Deep Sarode, 6th year medical student,
  2. Panagiotis Asimakopoulos, registrar in otolaryngology and skull base surgery,,
  3. David W Sim, consultant in otolaryngology and skull base surgery,
  4. Mohammed Iqbal Syed, consultant in otolaryngology and skull base surgery
  1. Department of otolaryngology and skull base surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to D Sarode deepsarode{at}
  • Accepted 8 June 2017

What you need to know

  • Aural microsuction is commonly performed to remove impacted wax, discharge, or foreign bodies where other measures have failed

  • The procedure can cause discomfort, pain, or dizziness, but less so than aural syringing

  • Following water precautions and avoiding the use of cotton buds can prevent recurrence of wax impaction and the requirement for further microsuction

A 48 year old man is referred to an ear, nose, and throat (ENT) clinic. He has pain and deafness from impacted ear wax, and the use of wax softening drops and aural syringing have not improved his symptoms. You feel that aural microsuction is indicated and want to explain this procedure to the patient.

Impaction of the ear with discharge, debris, wax, or a foreign body can often result in discomfort, pain, ringing in the ear, and hearing impairment, and is a common reason for presentation to primary care services. Some commonly used methods for wax removal are detailed in table 1.

View this table:
Table 1

Methods of ear wax removal

Most patients with symptoms respond to aural syringing. In a small proportion of cases, this method fails to either dislodge the wax or clear the wax sufficiently to improve symptoms, particularly if the ear canal is narrow. In these cases, referral to ENT might be needed for consideration of other methods to extract wax.1 Aural microsuction is an alternative method of clearing the ear canal using a suction device guided by microscope visualisation. It is the most commonly used method of ear …

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