Download earwax Information

When to remove earwax

If earwax is totally occluding the ear canal and
any of the following are present:
o Hearing loss
Earache
o Tinnitus
o Vertigo
o Cough suspected to be due to earwax
 If the tympanic membrane is obscured by wax
but needs to be viewed to establish a diagnosis.
 If the person wears a hearing aid, wax is present
o
and an impression needs to be taken of the ear
canal for a mould, or if wax is causing the
hearing aid to whistle.
Before removal you will need to use
Olive Oil Drops- Lie on your side with the affected
ear uppermost.
1. Pull the outer ear gently backwards and upwards to
straighten the ear canal.
2. Put 2-3 drops of olive oil into the affected ear(s) and
gently massage just in front of the ear.
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3. Stay laying on your side to allow the wax to soak in
for around 10 mins.
4. This needs to be done for 4 weeks.
5. An appointment is then needed for review. At this
time we may decide to move forward to ear
irrigation.
Removal methods not recommended

Advise people against inserting anything in the
ear. Cotton buds, matchsticks, and hair pins can:
o Damage the wall of the canal and increase the
likelihood of otitis externa.
o Cause the wax to become impacted by
o
pushing it further into the canal.
Perforate the tympanic membrane.
When to refer

Refer before irrigation if:
o
o
o
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The person has (or is suspected to have) a
chronic perforation of the tympanic
membrane.
There is a past history of ear surgery.
There is a foreign body, including vegetable
matter, in the ear canal.
There is a visible tympanic membrane
perforation
o Ear drops have been unsuccessful and
irrigation is contraindicated.
 Refer after irrigation if irrigation is
unsuccessful
o



Seek immediate advice from an Ear Nose and
Throat specialist if severe pain, deafness, or
vertigo occur during or after irrigation.
Refer or seek urgent advice if infection is
present and the external canal needs to be
cleared of wax, debris, and discharge.
If the person continues to experience hearing
loss after wax removal arrange an audiogram.

o
o
Current perforation of the tympanic
membrane.
A history of perforation of the
tympanic membrane in the last 12
months. Not all experts would agree
with this — some would advise that
any history of a perforation at any
time, even one that has been
surgically repaired, is a
contraindication to irrigation because
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o
o
o
o
o
o
a healed perforation may have a thin
area which would be more prone to
re-perforation.
Grommets in place.
A history of any ear surgery (except
extruded grommets within the last
18 months, with subsequent discharge
from an Ear Nose and Throat
department).
A mucus discharge from the ear
(which may indicate an undiagnosed
perforation) within the past 12 months.
A history of a middle ear infection in
the previous 6 weeks.
Cleft palate, whether repaired or not.
Acute otitis externa with an
oedematous ear canal and painful
pinna.
Managing recurrent wax

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Decide on the most appropriate treatment taking
into account the person's wishes, previous
successful treatment, and any contraindications.

Treatment options include: ear drops, irrigation,
or referral for manual removal of earwax.
 To prevent wax becoming impacted, advise that
regular use of ear drops may be helpful.
o Explain that there is no evidence to suggest
the best type of ear drops or how frequently
o
o
they should be used.
Experts suggest using either sodium
bicarbonate, sodium chloride, olive or almond
oil ear drops. The suggested frequency of use
varied from daily to once a fortnight.
It is not known if such treatment is effective
and the person may need to return for repeat
wax removal.
Complications

The following have been reported:
o Failure of wax removal
o Otitis externa
Perforation of the tympanic membrane
o Damage to the external auditory meatus
 Necrotizing (malignant) external otitis is a
rare infection, occurring primarily in
o
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o
o
immunocompromised people, especially
older people with diabetes mellitus, and is
often initiated by iatrogenic trauma to the
external auditory canal.
Pain
Vertigo
Otitis media due to water entering the middle
ear when there is a previous perforation.
o Exacerbation of pre-existing tinnitus.
o Serious injury to the middle and inner ear
(rare).
 Bleeding (usually self limiting).
 Nausea, vomiting, and vertigo may result from
temperature variations of the irrigating fluid.
o
Contraindications, cautions and warnings

Do not use ear irrigation to remove wax for
people with:
o A history of any previous problem with
o
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irrigation (pain, perforation, severe vertigo).
Current perforation of the tympanic
membrane.
o
o
o
o
o
o
o
o
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A history of perforation of the tympanic
membrane in the last 12 months. Not all
experts would agree with this — some would
advise that any history of a perforation at any
time, even one that has been surgically
repaired, is a contraindication to irrigation
because a healed perforation may have a thin
area which would be more prone to reperforation.
Grommets in place.
A history of any ear surgery (except extruded
grommets within the last 18 months, with
subsequent discharge from an Ear Nose and
Throat department).
A mucus discharge from the ear (which may
indicate an undiagnosed perforation) within
the past 12 months.
A history of a middle ear infection in the
previous 6 weeks.
Cleft palate, whether repaired or not.
Acute otitis externa with an oedematous ear
canal and painful pinna.
Presence of a foreign body, including
vegetable matter, in the ear. Hygroscopic
matter, such as peas or lentils, will expand on
o
o
o
contact with water making removal more
difficult.
Hearing in only one ear if it is the ear to be
treated, as there is a remote chance that
irrigation could cause permanent deafness.
Confusion or agitation, as they may be unable
to sit still.
Inability to cooperate, for example young
children and some people with learning
difficulties.
Use ear irrigation with caution in people with:
o
o
o
Vertigo, as this may indicate the presence of
middle ear disease with perforation of the
tympanic membrane.
Recurrent otitis media with or without
documented tympanic membrane perforation,
as thin scars on the tympanic membrane can
easily be perforated.
An immunocompromised state, especially
older people with diabetes, as there is an
increased risk of infection from iatrogenic
trauma to the external auditory canal in this
group of people.
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

Careful instrumentation should be employed in
people who are taking anticoagulants due to
increased bleeding risk.
Warn people with a history of recurrent otitis
externa or tinnitus that ear irrigation may
aggravate their symptoms.
July 2016
http://cks.nice.org.uk/earwax#!management
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