Ear wax removal: water irrigation versus microsuction
Current NICE guidelines recommends both water irrigation and microsuction as effective methods of ear wax removal. Here, I will take the opportunity to briefly define each method.
Water irrigation: pumping water into the ear canal to flush out any ear wax (wet method). This is typically performed using an electronic machine which regulates water temperature and pressure. Please note “old school” syringing with a large metal syringe is considered obsolete and is not NICE recommended and should not be performed as it is largely considered dangerous. Adverse risks associated with syringing include ear drum perforation, hearing damage and dizziness.
Microsuction: hoovering out the ear wax (dry method). This should be performed under direct light and magnification of the ear canal. Common visualisation tools used for microsuction include a head loupe, an endoscope or an ENT operating microscope.
So as a patient, which one should you choose and why?
Well, right now in the UK you will find more ENT consultants and audiologists favouring the newer method of microsuction for ear wax removal – including myself. GP practices will often still use water irrigation (IF they offer such wax removal services at all).
So what are the advantages of microsuction?
As a dry method we do not pump any water into the patient’s ear, the aim is simply to extract the wax. This is good news for patients with any history of ear surgery, mastoid cavities, scarred or perforated ear drums. In these circumstances, water irrigation is very much contraindicated. Building on this point, the main concern that I hold with water irrigation is this:
With waxy ears you simply cannot guarantee the health / status of the ear canal or ear drum as it is hidden behind the very wall of wax you seek to remove. So why risk pumping water into that space when you can just use dry suction instead?
Now one may counter this by relying on the patient’s history to rule out such contraindications. BUT, even if the patient reports no past history of ear surgery, perforations or ear problems you cannot assume normality. Many patients won’t be aware of their own current or past ear health and status. This is something I witness many times over in my clinic – uncovering infections, perforations, ear drum scarring, false fundus, abnormal lumps and bumps etc. etc.
The other huge positive of microsuction is your clinician is looking directly into your ear as he or she is removing your ear wax. If they do therefore uncover anything abnormal the procedure can be ceased immediately. With water irrigation, the clinician looks in to your ears before (visualising a wax blockage) and after irrigation. Some irrigators do attempt to address the issue of poor visualisation during the procedure by encorporating a light and magnification lense near the tip e.g. the Earigator. However these are still poor quality in my opinion and become redundant anyway once the irrigation nozzle and water jet is positioned into the patients ear canal.
What are the disadvantages of microsuction?
It can be noisy and some patients may not tolerate this such as young children or those with abnormal sound sensitivity or severely distressing tinnitus.
Ironically however, the wax will shield some of this noise and in the case of tinnitus, may even be the cause/exacerbating factor. The clinician should be mindful of time spent in the ear – most patients will be dewaxed within a matter of seconds to minutes.
Equipment can be very expensive compared to water irrigation. In particular, the tools used to visualise the ear. An ENT microscope can cost upwards of £10,000. BUT, this will afford the clinician better ear examination capabilities.
At Ear Care Specialists, we favour microsuction coupled with the use of an ENT operating microscope, for outstanding ear visualisation. We not only train fellow clinicians, we also see around 1,000 patients per year for this procedure and are proud to call ourselves experts in this field.
We’re experts in ear wax removal, we use a state-of-the-art ENT operating microscope to illuminate and visualise your ears in ultra high definition (the true gold standard for ear examination). We are then able to gently remove the ear wax using microsuction. Unlike syringing, this is a safe and dry method which does NOT require the pre-application of oil drops or wax softeners, which are often only necessary in a small minority of hard wax cases.
Talk to Dr. Jeff about your tinnitus
Simply book a comprehensive hearing assessment where we will thoroughly assess your hearing health and tinnitus symptoms, before making any clinical recommendations.
