The clinically safe method for ear wax removal as highlighted by the NICE guidelines is the microsuction method which has now predominantly superseded the ear irrigation(use of water) method of old.

It is a method that has its challenges depending on the nature of the case, namely the degree of impaction and the distal proximity to the eardrum. In clinic we see a great variety of patients with some presenting with routine cases whereby the cerumen is in the medial or outer two thirds of the canal and in a considerable degree of instances non routine cases where earwax has been pushed on to the eardrum itself. The latter of these two types of cases requires a great degree of both skill, training, and experience to remove safely and efficiently.

Most patients are unaware of the fact that most training programmes undertaken by practitioners usually allows for wax removal only up to the last third of the cavity, as a consequence of this we have found patients coming back to us after seeing other high street providers who have not been able to remove the wax from the eardrum and are thus still presenting with the acute symptoms associated with deeply impacted wax. The key to effective and safe wax removal on the eardrum is one we feel can only be undertaken with endoscopic camera technology and only by a skilled and very experienced audiologist.

Why cannot every professional remove ear wax on the eardrum?

The reasons from experience usually fall into a combination of reasons. One of the significant factors is the type of equipment used. The ear canal is usually between 24-27mm length so the depth of field and your ability to view the last third of the canal is critically important. Most practitioners use dental loupes of x2-3 mag which are sufficient to remove wax in the anterior first third of the cavity but certainly not from the bony canals or eardrum towards posterior third of the canal. Both the lateral walls and the bony isthmus in the back of the ear canal are very sensitive residing in a rich plexus of sensory touch, temperature, and pain receptors which if touched or disturbed can cause pain and discomfort. Endoscopic or microscopic viewing has a significant advantage in providing the depth and field of view to remove deeply impacted wax without disturbing the delicate sensory fibres running along the quadrants of the ear canal.

The second reason is usually experience. The ear wax removal industry is highly unregulated much like other similar healthcare industries like the aesthetics industry. If truth be told much like aesthetics, most healthcare professionals can pick up a certification of competence after attending a day course. These courses are available en masse for anyone who usually expresses an interest in removing ear wax with no prior audiological experience with any type of medical procedure associated with the human ear. A number of courses are now training pharmacists , footcare professionals, care support workers, amongst other non-related healthcare practitioners. This in in itself is not a problem or sour grapes from us as a business, however as trainers ourselves there is a genuine concern at how competent someone can be in a 6 hour course having only trained on a

dummy ear and mock wax camouflaged as peanut butter for practise. As a consequence, this leaves a rather large regression from the mean in the level of skill practitioners possess; thus, allowing for a situation whereby you could be the first real patient that someone might be “practising” on.

At the network every audiologist you will see will have had at least completed 1000 ears or have 5 years’ experience in conducting the procedure before we allow them to perform any procedure on our patients. The strict qualifying criteria is set in place by us is simply because of the volume of non-routine difficult cases that are now coming into clinic looking for a procedure. As a group we would say 60% of patients come into clinic with wax presenting on the eardrum, or very close to, usually because they have used a cotton bud or overused drops in the desperation to clear the ear wax on medical advice.

Furthermore, the long wait times most patients are now facing on the NHS is also bringing through patients with more complex pathologies. Our clinics are now seeing more and more patients with histories of cholesteatoma, chronic otitis externa infections, mastoidectomies, vestibular disorders, perforations amongst others. This is even more reason to choose wisely when picking who you choose to see and certainly what you should be expecting from a medical procedure. The procedure is fast becoming an aesthetic optional extra, promoted heavily on social media by influencers and for that matter professionals advising of the cosmetic benefits. We will add, this remains a medical procedure done only as a last resort when other options are exhausted.

With every medical procedure you will find risks. The key is to minimise the risk of tinnitus, vertigo, perforations, and cross infection. These although minimal in occurrence are still possibilities and the more skilled a practitioner the quicker and more painless the procedure is. Our patients do sometimes comment on the fact that the procedure itself is usually quick. We have found that it is important to spend no longer then ten minutes inside a patient’s ear canal due to the increase in the aforementioned risks the longer the procedure lasts.

We hope this article informs our patients or would be patients to make the right choice and to only see qualified audiological professionals and not to always pick the first google “ear wax removal near me search”.