Ear wax is a waxy substance made by modified sweat glands in the ear canal. It is usually a combination of dead skin (Keratin) cholesterols, alocohols and lipids. Generally speaking, there are two types of ear wax. The stringy dry type of wax generally produced in Asian populations and the wet sticky type of wax which is more commonly found in populations from European and African descent. In practise however we find lots of different variants ranging from wax which is often dry , crumbly, or even having a fudge like consistency.

The ear canal is quite warm and moist which is a perfect breeding ground for infection. The production of ear wax is designed to prevent or fight of infection in the cavity from bacteria and fungi. Ear wax has bacterial and and antifungal properties, it is slightly acidic with a PH of 6.1 to kill any bacteria or fungi in the canal. It is also quite sticky this catches any dust particles, debris, or foreign bodies as they enter the ear and then migrate that out of the canal naturally.

The ear naturally transports wax out of your ear like a conveyor belt. Keratin and dead skin in the back of the ear is shed and migrates out of the ear canal dragging wax along with it from the cerumunous and sebaceous glands, It does this at a rate of 0.2mm a day or 1.5mm a week. The whole cleaning cycle can take up to 4 months to clear from your ear ready for the next Sycle of self-cleaning to begin.

When we use cotton buds we often end up pushing the wax further back down the ear which then stops the natural migration of wax out of the ear. We sometimes end up removing the skin in the ear canal which again means there is no skin left to transport the wax out fo the ear which thus causes the accumulation of wax in the ear. Some patients have very narrow ear canals and often you find the first third of the canal may be so narrow that it does not allow for wax to naturally migrate out of the ear. We also find patients who have had middle ear operations tend to suffer as they have larger ear cavities which often means more wax accumulation as the wax simply cannot move out of the ear canal due to its larger size.

We use all 4 methods of wax removal

• Ear Irrigation for soft sticky wax
• Endoscopic microsuction
• Microsuction
• Manual extraction

Micro suction ear wax removal is the gold standard of ear wax removal. It offers a safer and more gentle way to remove ear wax than traditional irrigation methods. The technique involves using a endoscopic microscope or TTL surgical loupes and a medical suction aspirator with a suction pen.The procedure is quick and painless – it can take as little as a few minutes to extract the wax safely from the ear.

Although micro-suction requires very little intervention we always advise a few drops of olive oil in the ear to help soften the wax. We often find the softer the wax the easier it is to remove out of the ear. However in saying that the over use of drops can turn the wax in to a viscous sticky liquid in the ear which can slide on to the eardrum so try not to use drops excessively.

We would recommend olive oil drops for 1-2 days or Otex but this is dependant very much on an individual to individual basis

We also provide water irrigation for the ears. For some patients microsuction is not always stable especially when dealing with particularly soft wax as a consequence of over use of drops. In such cases we use the irrigation method which involves the controlled pressure of water at body temperature in the ear in order to remove stubborn deposits of wax which deposit themselves on th eardrum. Your clinician will determine which would be the better procedure on the day of the appointment.

Ear wax removal drops usually peroxide based including name brands like Otex and Sodium bicarbonate drops are great for breaking down hard abrasive wax in the ear ready for ear wax removal. In some instances they can break down wax sufficiently to the extent were by earwax removal may not be required as the wax has sufficiently dissolved, however we find that this in most cases depends on the size of the cavity. We usually deal with a lot of cases were by the wax has turned in to a semi liquid which slides down the ear canal and settles on the drum completely sealing the canal. and causing complete deafness, our advise is to use drops for 2-3 days before coming in for an earwax removal.

We always advice a qualified Audiologist or a practitioner nurse with experience in ear nose and throat. Any other practitioner with a background not in Audiology simply wont have the experience to deal with complex difficult cases and you usually want a audiologist with 100’s of ear wax removal procedures under their belt. We say this because unfortunately due to the unregulated nature of the training you could potentially be having a invasive procedure undertaken by a non audiologist with no previous experience in audiological medicine.