There are numerous methods of ear wax removal. Some can be performed at home, while others must be performed by a professional. Here we have outlined the different methods and the pros and cons of each one:
Ear DropsEar drops can be bought from the chemist over the counter and are the cheapest method of wax removal. Ear drops are commonly marketed as a cheap way of removing earwax at home. For an ordinary member of the public, the choice of different branded and unbranded products can be overwhelming.
Olive oilOlive oil ear drops are the gentlest type. The olive oil softens the edges and outer surface of the wax and is well-tolerated by most people. Some more expensive versions have added menthol to produce a cooling sensation, or eucalyptus to give a pleasant smell.
• Pros: cheap; gentle; generally well-tolerated; can be used for extended periods
• Cons: can take a long time to work on its own; can make the ear feel bunged up,;added ingredients may not be so well-tolerated
Other Oil BlendsSome proprietary brands contain blends of light oils that soften ear wax.
• Pros: gentle; possibly faster acting than olive oil
• Cons: more expensive than olive oil; wax can sometimes dissolve and slide further down the ear canal, rather than coming out.
Sodium BicarbonateSodium bicarbonate / bicarbonate of soda ear drops are alkaline, while ear wax is acidic. Therefore they work by chemically dissolving ear wax rather than softening it, and work much quicker than olive oil. They can be used for a day or two by most people without any problem.
• Pros: also cheap; tolerable for a day or two; quick
• Cons: wax can sometimes dissolve and slide further down the ear canal, rather than coming out; extended use can strip the protective lining of the ear canal and lead to infection.
Peroxide-BasedSome ear drops, including proprietary and chemist own-brand, are based on peroxide in some form, often urea peroxide. When compared to sodium bicarbonate drops, peroxide-based drops are similarly effective, but also effervesce.
• Pros: quick
• Cons: more expensive than sodium bicarbonate drops; wax can sometimes dissolve and slide further down the ear canal, rather than coming out; contain peroxide (bleach), and some individuals can experience a painful reaction even immediately after one application. For this reason we don’t recommend peroxide-based drops.
In general, ear drops can sometimes take weeks to work, and hearing will often get worse before it gets better. There is also the possibility that the wax will slide further down the ear canal, form one large lump, and completely block the ear. Ear drops are not recommended if you have a perforated ear drum.
Ear SpraysEar sprays can be water-based or oil-based. They usually incorporate a conical nozzle that is placed into the entrance of the ear canal and the spray is then applied.
Water-BasedWater-based ear wax removal sprays can be effective if the amount of wax blockage isn’t too great. They are often simple saline, or may be sterilised sea water.
• Pros: gentle; salt water based; well tolerated
• Cons: may push wax further into the ear by the force of water; water may get trapped behind wax and create a “head under water” feeling
Oil-BasedOil-based ear wax removal sprays, such as EAROL, are great for softening wax prior to other procedures, and are very effective at penetrating wax due to their small droplet size.
• Pros: cheap; safe; penetrate wax better than drops; reach further into the ear because of spray; great preventative measure when used once a week
• Cons: may not remove wax on their own
Ear Syringing / Ear IrrigationEar irrigation is normally performed by a GP practice nurse, a disrict nurse, and by some Audiologists. Traditionally, a metal ear syringe was loaded with warm water, the metal tip placed into the ear canal. The water was then squirted into the ear canal and a kidney dish was held under the ear to catch the water and and wax that was flushed out. The syringe would have to be regularly lubricated to allow a smooth level of pressure to be applied, and the nurse would use his or her judgement as to how forcefully to syringe the water. Syringing can’t shift hard wax, so it must be softened for up to two weeks before syringing is performed.
Nowadays, for safety reasons the metal ear syringe has been replaced by an ear irrigator pump with a jet tip. The pump has a variable, regulated pressure, but the process is essentially the same. Many people have had their ears syringed or irrigated many times without any issue arising. Here are the pros and cons of ear syringing:
• Pros: usually free on the NHS; when it works it works well
• Cons: cannot remove hard wax; can push wax further into the ear if the angle of the jet is slightly off; may cause tinnitus; may perforate the eardrum; an undiagnosed perforated ear drum may not be seen due to the amount of wax, causing water, bacteria, wax and dead skin cells to be flushed past the eardrum into the middle ear, potentially causing a painful infection; not recommended following ear surgery; should not be performed when the ear drum has previously been perforated due to the risk of re-perforation.
Due to the long list of potential complications listed above, many surgeries are withdrawing their ear syringing service, and are referring all patients to the NHS ENT clinic, which may have a long waiting list.
Dry Instrument RemovalDry instrument ear wax removal is normally performed by an ENT surgeon or an Audiologist. The pratitioner uses a selection of different shaped instruments called Jobson Horne probes or curettes. These are like miniature spoons and loops that are used to hook or scoop the wax from the ear canal. It is normally perfomed under illumination. There is a great choice for the practitioner of metal, or plastic disposable curettes, and some of them even have their own light built in. The practitioner will usually apply some Earol to loosen the wax from the ear canal wall before performing the procedure. The tip of the curette is normally pushed past the wax and the drawn back out, bringing the wax with it.
• Pros: quiet – so great for those who don’t like noise; quick – often the wax can be removed in one or two big lumps
• Cons: small possibility of pushing the wax deeper into the ear; hard wax may be uncomfortable to remove
Micro Suction Ear Wax RemovalMicrosuction is by far the most effective method of earwax removal. Tradionally only performed in ENT clinics due to the size and weight of the equipment, it can now be performed by appropriately trained individuals in smaller clinics due to portable suction pumps and operating microscopes that are now available.
Micro suction is made up of two words: “Micro” refers to the operating microscopes that can either be large floor standing units, or can be incorporated into glasses, in whch case they are known as operating loupes. “Suction” refers to the medical suction pump that is attached to a tube and a 2 millimetre suction wand, which is used to suction the wax from your ear.
Micro suction requires a good knowledge of the anatomy of the ear, along with training in how to safely use the equipment. For this reason, microsuction is performed by ENT surgeons and Audiologists, who both specialise in the ear, and by specialist nurses who have had further training.
Micro suction only removes wax from the ear – because it doesn’t spray water into the ear it is safe to use after ear surgery, or when the eardrum is perforated. The Micro Suction Practitioner uses a powerful operating microscope and a bright light source, so he or she can see exactly what is happening inside your ear, so the procedure is the safest of all.
• Pros: safest method; can be used after ear surgery; can be used where the eardrum is or has been perforared; painless; virtually no risk of infection; usually quick
• Cons: possible slight discomfort if wax hasn’t been pre-softened; can sometimes require a second visit (in the case of severly impacted wax); some people find it a little noisy (although clinical studies show that the noise levels are safe)
Cotton BudsCotton buds are small buds of cotton wound around either a plastic or wooden stick. Many people use them in their ears seemingly without any ill effects. However, other people find that cotton buds push in as much wax as they get out, and over time this wax gets pushed together to form a hard lump, known as “impacted wax”. Impacted wax can be so hard that it causes pain as it pushes against the sensitive skin of the ear canal, and can even push against the very delicate eardrum, causing pain and possibly a perforation. If you look inside someone’s ears after they’ve used cotton buds, you often see tiny scratches and minor bleeding: although cotton buds feel soft to our finger tips, they are actually quite harsh on the very thin skin of the ear canal. Our advice is don’t stick cotton buds in your ears. If your ears are itchy you most likely have slightly dry skin and will benefit more from using Earol once a week. Itchy ears may be a sign of a fungal ear infection, so if you your ears are itchy, get your GP to have a look inside just in case.
Pros: cheap; temporarily relieve itching; some people use them without any issues; get some wax out Cons: tend to push in as much wax as they get out; scratch and irritate the sensitive skin of the ear; stimulate more wax production; can cause pain and/or perforate the eardrum.
Home Use Ear Vacuums“Ear vacuums” can be bought online, and many people feel that they are effective. However, look into their ear after using one (you’ll need an otoscope to do that!), and you’ll see that the wax is still there, and may have been pushed a little further down the ear canal. Often the ear vacuum will have some wax on the end, but that is not due to the vacuum itself. Rather, it is merely due to mechanical contact with the wax, the same way that a cotton bud will pick up some wax, but push more in than it gets out. Anything thay is strong enough to suction wax from the ear would need to be a medical device adapted for the purpose, and be operated by a trained professional to ensure that it is done safely. You can be assured that a product that is available online for under £10 will not be strong enough, and furthermore will not be a medical device adapted for suction of wax from the ear!
• Pros: makes a whirring sound; feels nice to use; fairly cheap
• Cons: despite being cheap, a complete waste of money; pushes in as much wax as it gets out
Ear CandlesEar candles are an alternative therapy that can potentially cause sever e injury to the ear. The Hopi indian tribe strongly deny ever having invented such a thing. Ear candles are made up of wax and paper that is rolled into a cone that is thinner at one end. The wide end is placed into the ear canal and the thin end is lit. A flame burns at the end of the candle. There have been incidents reported in ENT literature of hot candle wax dropping onto the ear drum, immediately destroying the ear drum and causing permanent hearing loss. Even though this is quite rare, it isn’t a risk worth taking.
Investigations have been carried out into whether ear candles remove any ear wax at all. Ear candling practitioners proudly cut open ear candles to show their clients how much wax has been removed. However, when measured the amount of updraught created by the candle is insufficient to remove ear wax, especially when it is working against gravity. When filmed over a clear glass, you can actually see a stream of wax and soot coming downwards from the bottom of the candle and coating the bottom of the glass. If that was in your ear, it would be coating your eardrum. If the updraught isn’t enough to lift tiny soot particles, it certainly isn’t enough to lift lumps of ear wax. So, if the lumps in the ear candles aren’t earwax, what are they? It turns out that they are composed of burnt candle wax and paper, exactly what you would expect if you lit a candle made from wax and paper!
• Pros: practitioner often plays relaxing music, and may also give a foot massage
• Cons: may cause severe pain and permanent hearing loss; not worth the risk