Ear wax (also known as cerumen) build-up is one of the most common reasons people seek hearing care to begin with. Ear wax serves an important role in our ear health and hygiene - in fact, ear wax is part of how your ear naturally self-cleans. The skin of the ear canal kind of behaves like a very slow conveyor belt, where it grows outward at a rate of 1-3mm per month. This 'conveyor belt' is also aided by natural jaw movements, such as chewing or talking. As the skin moves outward, it also naturally secretes ear wax which helps lubricate the skin, trap dirt and other foreign objects, and helps to repel insects and prevent infection. It then slowly carries out the dead skin and trapped dirt/debris, and will eventually fall out of your ear.

Now, what happens when this process is interrupted? Perhaps you've used a cotton tip inside your ear canal (a big risk of ear injury!). Or maybe you use earphones frequently, or it's something that you've been responsibly encouraged to do - such as wearing something inside your ears like hearing protection or hearing aids for most of the day. These can interfere with the ear's natural wax migration process and increase the risk of wax becoming trapped within the ear canal. Sometimes it may not necessarily be due to something in your control, as even having naturally narrow ear canals or having various skin conditions can also lead to greater ear wax build-up. Complete ear wax impaction can cause a conductive hearing loss of anything up to 45dB, which is similar to wearing hearing protection! This is where professional ear wax removal (or "ear cleaning") services come into the picture.

There are several methods available to remove ear wax. The two most common methods are microsuction and ear syringing. Both of these can be effective, however, they each work very differently. This article will aim to explain the differences and help you understand which may be most suitable for you.

Signs You May Have Ear Wax Build-Up

Some signs of ear wax build-up could be:

• Blocked feeling

• Reduced hearing

• Tinnitus

• Itching

• Hearing aid feedback, also referred to as 'whistling' (if you wear a hearing aid)

• Ear fullness

If you experience any of these symptoms, you may benefit from a hearing assessment and examine for ear wax.

What Is Ear Syringing?

Ear syringing (also sometimes called irrigation) has been used for many years. Essentially, warm water is syringed into the ear to flush wax from the ear canal, which can be an effective option, particularly for softer wax.

What Is Microsuction?

Ear wax is removed using a small medical suction device. There is no water required making it a dry removal option. The clinician can perform this under direct visualisation, allowing targeted removal of the wax.

Key Differences

1. Visibility: With microsuction, the clinician can see the wax during removal - it's targeted. They will typically use a microscope or magnified scope during the process. With syringing, water is used to flush wax out without directly removing it under continuous supervision.

2. Water Use: Microsuction is a dry procedure, whereas syringing requires water. It isn't uncommon for people to mention that they don't like water in their ears, for this reason they might feel a bit uncomfortable.

3. Comfort: Comfort varies between individuals - so naturally some people prefer microsuction but others might tolerate irrigation well.

4. Suitability: Microsuction may be preferred when there is an ear drum perforation, previous ear surgery, hearing aids are worn, there is irritation or infection present, irrigation has failed previously, or the patient is prone to ear fungal infections.

Common Misconceptions

1. Is microsuction painful?

Usually, microsuction is well tolerated. Although it may feel a bit unusual having wax gently suctioned out of the ear canal, it typically doesn't cause discomfort. The exception may be very hard wax that is touching or 'stuck' to sensitive skin might occasionally cause some discomfort - however, this isn't isolated to microsuction techniques. In these instances, you may be advised to use a wax softener spray for a few days to help 'unstick' it painlessly first, and then return to finalise the microsuction process.

2. Is syringing dangerous?

Ear syringing is generally safe when performed appropriately. Like all procedures, it has risks and limitations.

3. Is microsuction always better?

Not necessarily. The best method depends on the patient's individual circumstances. Other considerations can be cost/accessibility, for example a GP practice may offer bulk billing or some degree of Medicare assistance with ear syringing that can be performed at the practice, whereas an audiologist offering microsuction will not have access to Medicare funding for wax removal performed by them.

How We Decide Which Method To Use

At Solo Audiology and Hearing, we use the ear wax microsuction technique and complement this with manual removal (curette) where appropriate and required. We first obtain a detailed medical and ear health history of the patient, then following this we will closely examine the ear, ear canal, and ear drum using a high-definition video otoscope (meaning you can see it too). As it's on the monitor, we educate you on what we are looking at so you are fully informed. The recommended process is then discussed in depth, and the wax removal is performed in the clinic with a head-worn microscope and microsuction.

Take Home Message

Both microsuction and syringing can be effective, it really depends on the individual patient's circumstances. At Solo Audiology and Hearing, we use microsuction with curette techniques where required. The goal is always safe and effective removal of ear wax whilst protecting the health of the ear.

Written by Daniel Gerace, Clinical Audiologist and Owner of Solo Audiology and Hearing.