Guide to earwax build-up

The build-up of ear wax is a common problem and while it’s uncomfortable and annoying, the good news is that it can be treated. There are a number of ways to remove a build-up of ear wax, which is why we’ve created this extensive guide so you can understand the different options available to you.

As well as exploring each of these techniques in more detail, we explain the causes of ear wax build-up and list some of the common symptoms.

The causes of ear wax build-up

The build-up of ear wax can be caused by a number of factors. Some of these may be genetic, such as the way your ears are shaped, or they may be connected to an illness and loud noises. The most common causes are:

  • Narrow ear canals
  • Damaged ear canals
  • Lots of hair in the ear canals
  • Skin conditions that affect the scalp or the skin around the ear
  • Inflammation of the ear canal – this is known as ‘otitis externa‘ or ‘swimmer’s ear’

The symptoms of ear wax build-up

A build-up of ear wax can cause numerous symptoms, and no two people may experience the exact same ones. Left untreated, these symptoms will only get worse and could result in long-term damage. The most common symptoms to be aware of are:

  • Earache
  • Hearing loss – struggling to hear is a sign of a blockage, which will worsen without attention
  • Tinnitus – hearing sounds coming from inside your body, rather than external sources
  • Itchiness, which can occur in or around your ear
  • Vertigo – a spinning sensation, similar to dizziness
  • Ear infections – an excessive build-up of ear wax will leave you exposed to ear infections which are painful and uncomfortable

The main methods used to remove the build-up of ear wax

To remove excess ear wax, there are typically four main methods of treatment that are most commonly used. These are ear wax drops, ear stringing (also known as irrigation), endoscopic ear wax removal and micro-suction ear wax removal. We have explained all of these methods below so you know how they work and the potential risks or side effects of each one.

Ear wax drops

What is it?

Ear wax drops are the most common solution for dealing with an excess build-up of ear wax. These can be bought over the counter from pharmacies, making it a very accessible solution.

Ear wax drops can be oil-based or water-based. The oil-based drops are made from olive oil while the water-based solutions will be made from either saline or sodium bicarbonate. Designed to loosen, soften or dissolve your ear wax, water-based ear drops are typically considered more effective than oil-based ones.

Potential side effects, risks and disadvantages

The drops must be kept at room temperature to prevent the ‘caloric effect’. This is when the balance organ in the ear becomes out of sync, leading to dizziness and vertigo. Ear wax drops should be avoided if you’ve had a perforated eardrum before as this may cause issues with middle ear infections.

Drops can be an effective solution, but it’s also a messy one. To properly apply ear wax drops, tilt your head and make sure the symptomatic ear is facing upwards. After the drops have been applied, you must keep your head in this position for between 5 and 10 minutes. Once this time has passed, you can sit up and wipe away any excess solution that leaks out. This process should be done 2-3 times per day for 10-14 consecutive days. If the build-up hasn’t cleared after you finish the treatment and you are still experiencing discomfort, you may need to consider another option.

Ear syringing/irrigation

Ear irrigation is the process of flushing wax out of the ear using pressure. Dangerous when not done correctly, a practice nurse, district nurse or audiologist will usually perform ear irrigation. Traditionally, the treatment used a metal ear syringe that was filled with warm water and placed into the ear canal. The water was then released into the ear, whilst a dish was held under the ear to catch any water and excess wax.

However, this method came with a number of risks, with the potential to damage the ear canal and cause an infection. Nowadays, an ear irrigator pump with a jet tip is used instead. The pump has variable, regulated pressure that the nurse will set according to the severity of the build-up to ensure the treatment is performed safely.

Potential side effects, risks and disadvantages

When performed properly, irrigation does work, with many people saying it is highly effective. However, this method does also come with some risks and disadvantages. Some of these are:

  • For syringing to be safe and effective on harder wax, the wax must be softened for 2 weeks prior, usually via drops.
  • If the jet angle is slightly off, it can push the wax further into your ear.
  • It can cause tinnitus.
  • The eardrum can be perforated.
  • Perforated eardrums can go undiagnosed if visibility is limited due to the wax. Using irrigation at this point could cause water, bacteria, wax and dead skin cells to get into the middle of the ear, leading to a painful infection.
  • It’s not recommended if you’ve had ear surgery.
  • It’s not recommended if the eardrum has been perforated before.
  • It shouldn’t be performed on anyone with a cleft palate, a known perforation, a mastoid cavity or a foreign object in the ear canal.

Micro-suction ear wax removal

This method is normally used when the two above have been unsuccessful. It’s typically performed in a hospital outpatient clinic by ENT doctors or nurses, who use ENT binocular operating microscopes to visualise the wax. Then, a suction probe that has been sterilised and is connected to a gentle suction machine is used to essentially ‘suck’ the wax out. Unlike other procedures, this is a completely dry method. This can significantly reduce the risk of damage and possible infection of the eardrum.

Potential side effects, risks and disadvantages

Like every procedure, micro-suction removal does come with some side effects and risks too. Some of these are:

  • The suction machine can be noisy, making the procedure uncomfortable.
  • Flaps of dry skin can vibrate, causing discomfort.
  • It can cause or worsen tinnitus.
  • If the suction probe grazes or scratches the ear canal, there is a chance bleeding can occur.
  • It may cause the caloric effect because of the cooling sensation of the suction probe. This can make a patient feel dizzy, but it will pass once the temperature regulates.

Endoscopic ear wax removal

Endoscopic ear wax removal is an alternative procedure similar to micro-suction that is arguably quicker and easier. It uses a more advanced medical ear torch than the conventional otoscope when inspecting the ear, which is called an oto-endoscope.

A doctor or nurse will insert the fine rod, which contains fibre optics, into the ear canal to illuminate it before using a series of lenses to relay the view. This provides the visualisation needed so that the ENT specialist can safely use the suction probe to remove the excess wax.

Potential side effects, risks and disadvantages

Typically speaking, there are very small risks that come with this treatment. These are:

  • It can be a noisy procedure, which can be uncomfortable and irritating for the patient.
  • There have been some reports of it causing or worsening tinnitus.
  • There is a chance of some bleeding due to the grazing or scratching of the ear canal, but this is much less likely compared to micro-suction as there is more operating space available.
  • It may cause the caloric effect, which can lead to temporary dizziness.

If you’re suffering from a build-up of wax and would like to learn more about potential treatment options, speak to us at London Hearing on 020 3075 3190.