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An article was published last year by the the RACGP (Royal Australian College of General Practitioners) to inform GPs in Australia about how to best manage patients with impacted ear wax. Below is a summary of some of the key points made. Here is a link to the article for your own perusal - RACGP ARTICLE.
KEY POINTS
Why does ear wax accumulate? The ear canal has a natural self-cleaning mechanism that pushes wax out laterally. If this mechanism is disturbed, wax can accumulate and become impacted. Things like narrowing or obstruction of the ear canal due to anatomical changes (e.g. exostoses or swimmer's ear), ear infections or dermatological diseases can all alter this natural migrational ability of the ear canal. Irritation arising from placing objects into ones ears (e.g. hearing aids, cotton buds and ear buds) can disturb the very sensitive layer of skin in the ear canal that can in turn alter the normal skin migration. Hearing aids and cotton buds also tend to push wax back in further down the ear canal never allowing or severely compromising the ability of the ear to self-clean. Lastly, as we get older, the glands responsible for wax production tend to produce drier wax which migrates much slower.
Symptoms of Impacted Wax (Impacted wax occurs when it obscures visualisation of the ear drum)
Most GPs agree that symptomatic wax should be removed although on average, 1/3 of patients who present with impacted wax will have their wax come out naturally within in 5 days without any intervention (3). Of course, wax should be removed for optimal hearing with or without hearing aids as well as in helping audiologists administer accurate audiometric hearing tests. The article then goes on to talk about the safety precautions GPs need to adhere to when using the syringing method to remove wax. Interestingly, the authors do not think that direct visualisation of the ear canal is necessary to perform safe and effective syringing. The view of Comfort Clean Ear is that the ear canal has very delicate skin and anatomy all in close proximity to each other. If you cannot see where you are firing pressurised water, complications may invariably occur. This is probably why 1 in 5 medico-legal cases against GPs is due to complications arising from water syringing. Contra-indications to the syringing method (anyone who has experienced anything in the list below should avoid having the syringing method used on them)
Side Effects and Complications of the Syringing Method
The last part of the article looks at micro-suction as an alternative method for the removal of impacted wax under microscopic observation. It points out that the micro-suction procedure (as is offered at Comfort Clean Ear) 'has the advantage of not exposing the ear to moisture and thus has fewer contraindications and is associated with a lower frequency of infections'(5). From this, it would be safe to say that ear wax removal using the micro-suction method under microscopic observation is the safest and most effective method available to remove impacted wax and is why it is the preferred option by ENTs around Australia. References (1) Bird S. The potential pitfalls of ear syringing: Minimising the risks. Aust Fam Physician 2003;32:150–51. (2) McCarter DF, Courtney AU, Pollart SM. Cerumen impaction. Am Fam Physician 2007;75:1523–28. (3) Keane EM, Wilson H, McGrane D, Coakley D, Walsh JB. Use of solvents to disperse ear wax. Br J Clin Pract 1995;49:71–72. (4) Bird S. Ear syringing: Minimising the risks. Aust Fam Physician 2008;37:359–60. (5) Roland PS, Smith TL, Schwartz SR, et al. Clinical practice guideline: Cerumen impaction. Otolaryngol Head Neck Surg 2008;139:1–20.
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Micro-suction
This method is used by Ear, Noise and Throat Specialists for a reason. It is the safest way to remove wax professionally and ensures every last vestige of wax is removed. It is also usually more comfortable than traditional water syringing. This is the method we at Ear Suction Clinic use. It is quick and easy and a patient is usually out within 10 minutes. For more information about our technique, please visit our webpage here. SAFETY: 9/10 EFFECTIVENESS: 9/10 COMFORT: 9/10 TOTAL SCORE: 27/30 Water Syringing Water syringing has been used by doctors and GPs for decades and given the risks, imprecision and discomfort involved, it is a wonder why it is still being used. The RACGP published an article in 2015 saying how 1 in 5 medico-legal cases involving GPs is due to problems arising from syringing. This is because there are greater risks to ear drum perforations, ear infections, increase or start of tinnitus, vertigo and more. Why subject yourself to this antiquated 'hope for the best' procedure (often requiring more than one appointment) when your can treat yourself to micro-suction? GPs in the UK and increasingly in Australia have seen the light and are referring more and more patients to micro-suction clinics. SAFETY: 5/10 EFFECTIVENESS: 6/10 COMFORT: 3/10 TOTAL SCORE: 14/30 Water Irrigation Water irrigation brought traditional syringing to the 21st Century. Instead of blasting the patient with water, water irrigation seeks to provide a controlled propulsion of tempered water to dislodge the wax. Whilst this is indeed an improvement over syringing, a lot of the short comings and risks associated with syringing are still present. The fact that you are introducing water to the very delicate ear canal increases your risk to an ear infection. The method is still imprecise as there is no real-time visual observation of the ear canal just like in syringing, unlike in micro-suction where the ear canal and target wax is observed the whole time. Just like in syringing, wax can also still get pushed deep down to the ear drum in this method making the situation worse for the patient. In micro-suction, wax is withdrawn not pushed in further. SAFETY: 6.5/10 EFFECTIVENESS: 6/10 COMFORT: 6/10 TOTAL SCORE: 18.5/30 Ear Candling As the name suggests, ear candling involves placing a candle in the affected ear and using heat to withdraw the wax. Unfortunately in theory, this doesn't actually work. It may feel good but there is no scientific validation of this technique. There is however countless occurrences of individual suffering from burns to inside their ear canal and even worse, to their ear drum. We would caution anyone thinking of using ear candling to remove wax. SAFETY: 3/10 EFFECTIVENESS: 0/10 COMFORT: 9/10 TOTAL SCORE: 12/30 Ear Buds or Variants Studies have shown that using ear buds feels good and is probably why many people use them. Unfortunately, they are probably making their earwax problem worse. Earwax or ceruman is produced by wax glands near the entrance of the ear canal. By using ear buds, you risk pushing this wax deeper into the ear canal. New wax is then produced and before long your ear canal can become completely blocked from the ear drum outwards. Not a fun experience for anyone involved. At Ear Suction Clinic, we see patients all the time who have used ear buds and pushed the wax deeper and some who have even caused damage to their ear canal walls where bleeding has occurred. Bottom line, don't use ear buds. They are more dangerous than you think. SAFETY: 3/10 EFFECTIVENESS: 3/10 COMFORT: 9/10 TOTAL SCORE: 15/30 Ear Drops By the time ear drops are recommended, you probably will need to get the wax removed professionally. Ear drops are more beneficial as a preventative measure for earwax build-up and will not remove wax that has accumulated. If using ear drops for prevention sake, we recommend everyday olive oil. We have written an article about ear drops which you may want to see here. SAFETY: 6/10 EFFECTIVENESS: 2/10 COMFORT: 7/10 TOTAL SCORE: 15/30 SUMMARY: Micro-suction => 27/30 Water Syringing => 14/30 Water Irrigation => 18.5/30 Ear Candling => 12/30 Ear Buds => 15/30 Ear Drops => 15/30 To book an appointment to have your ears cleaned via micro-suction, call 1300 380 060 or book online here. Your ears will thank you. |
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December 2018
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