EAR WAX

What is ear wax?

Ear wax is a build-up of dead cells, hair, foreign material such as dust, and cerumen. Cerumen is the natural wax produced by glands in the ear. t forms a protective coating of the skin in the ear canal. Small amounts are made all the time. Flakes or crusts of ear wax break off and fall out of the ear from time to time.

The quantity of earwax made varies greatly from person to person. Some people form plugs of earwax in their ear canal. This may cause a feeling of fullness and dulled hearing. It can feel uncomfortable. A hard plug of ear wax can also sometimes cause ‘ringing in the ear’ (tinnitus) or even a mild type of dizziness (vertigo).

A doctor or nurse can look into the ear canal and confirm a plug of ear wax has formed. A plug of ear wax is not a serious problem, more a nuisance. You only need to remove ear wax if it is causing symptoms such as dulled hearing. Ear wax may also need to be removed for fitting of a hearing aid, or if a doctor or nurse needs to examine your ear drum.

Note: do not try to clean the ear canal with cotton wool buds, etc. This can make things worse, as you will push some ear wax deeper inside. It may also cause an ear infection. So, let the ear clean itself.

What can I do if ear wax builds up and causes symptoms?

1. Sodium Bicarbonate Ear drops (available online or from Pharmacies)

Ear drops alone will often clear a plug of ear wax. You can buy drops from pharmacies. Alternative to Sodium Bicarbonate ear drops include – olive oil, almond oil and sodium chloride ear drops which are all commonly used for this purpose and available to buy online or from local pharmacies. Warm the drops to room temperature before using them (let the bottle stand in the room for about half an hour). Pour a few drops into the affected ear. Lie with the affected ear uppermost when putting in drops. Stay like this for 5 minutes to allow the drops to soak into the ear wax. The ear wax is softened and it often breaks up if you put drops in 2-3 times a day for upto 2 weeks. Flakes or crusts of ear wax often fall out bit by bit. You may not notice the wax as it comes out of your ear.

2. Ear bulbs for ear wax removal (online or from pharmacy)

If the wax does not clear after the use of ear drops, you can self-treat with a Bulb Syringe. A bulb syringe is a small bulb shaped rubber object that will fill with water and allow the user to squirt the water gently into the ear to remove ear wax. You can buy it from most pharmacies or online. The benefits of an ear bulb are:

You can use it yourself without needing to make an appointment to see the practice nurse.
Reduces the risk of infection from standard ear irrigation.
Many patients who use the bulb syringe are successfully treated.
The patient can control the water pressure applied in the ear and respond to any discomfort.
It is cheap to buy and can be reused so you can repeat the procedure if required.
Hearing aids can benefit from regular ear wax removal, as the dense wax can sometimes lead to feedback and whistling noise and affect the quality of sound from the hearing aid.

How to use an ear bulb

(If you experience any pain during this procedure stop immediately and see the practice nurse for review)

Put some clean warm (not hot) water into a bowl. Squirt the bulb syringe in the water a few times to fill it up with warm water.
Hold your head to one side so the affected ear is facing upwards. You can do this in the shower or bath or lay on the bed with a towel underneath your head.
Gently pull your ear in an upwards and outwards direction so that the water gets better access to the ear canal. Hold the nozzle inside the ear canal (not too deeply) and gently squirt the water from the bulb syringe into the ear. You can gently squirt more water into the ear if needed. Leave the water in your ear for 1-3 minutes to soften the wax.
Tilt your head over the sink so the water can fall out. Wiggle the outer part of the ear to help the water and wax come out.
Repeat for the other ear if both ears are affected.

Do not use a bulb syringe in the following circumstances:

If you have a history of ear drum perforation in the affected ear.
Symptoms of infection in the ear – usually pain or a smelly discharge.
Previous surgery on the affected ear.

3. Lastly Ear irrigation (formerly known as ear syringing) – Only book an appointment for this if there is still no improvement after use of Sodium Bicarbonate ear drops for 2 weeks and you have trialled using a ear bulb

Ear irrigation may be needed if ear drops and an ear bulb do not work. However as there are risks of infection, inflammation or even perforation, we do not advise this as first or second line treatment and only as an absolute exception.

With this procedure, the canal is washed out with warm water. But it is only safe if the plug of earwax has been softened. Irrigation when the wax is hard increases the risks of perforating the ear drum. Therefore, use ear drops (such as olive oil ear drops) to soften wax 2-3 times a day for 2 weeks before you have ear irrigation. f you have not used ear drops as directed then the irrigation is not likely to be successful and you will need to come back to the surgery another time. If your hearing has improved then please cancel the ear irrigation appointment as it will not be needed.

Ear irrigation is usually painless. Lukewarm water is squirted into the ear canal. This dislodges the softened plug which then falls out with the water. Washing is stopped if you feel discomfort. Your ear is examined with a light and is checked by the Nurse/HCA before you leave.

Some people feel dizzy after ear irrigation but this quickly settles. The ear canal may be prone to infection for 4-5 days until more wax is produced to protect it. Some people develop an inflammation in the ear canal following ear irrigation. This causes itch and discomfort but can be treated with ear drops. Rarely, ear irrigation can cause damage to the ear or eardrum. Therefore, see a doctor or nurse after ear irrigation if you:

Develop any ear pain.
Develop troublesome itch in the ear.
Develop a discharge from the ear.
Have swelling of the tissues around the ear canal (which may indicate infection).

Ear irrigation may not be advised if you have certain ear problems. In particular, if you:

Have had complications following this procedure in the past.
Currently have grommets in place (grommets are small plastic tubes placed in the eardrums in an operation).
Have had ear surgery in the past (apart from grommets that have come out at least 18 months previously and you have been discharged from the hospital ear department).
Have a cleft palate (even if it has been repaired).
Have an ear infection or have had an ear infection in the previous six weeks.
Have recurring infections of the ear canal (recurring otitis externa).
Have, or have had, a burst (perforated) ear drum.

If ear irrigation does not work, or is not advised, you may be referred to an ear specialist for removal of troublesome ear wax and this is a safe procedure called Microsuction of the ear canal.