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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.  One of the first things a GP will get a patient to do when asked to remove ear wax is to go to the chemist and use ear drops. After a few days of using ear drops, a patient will often ring Ear Suction Clinic saying that they have been using ear drops and the blockage in the ear is now worse. What is going on?
A lot of the products purchased at the chemist for ear softening are peroxide based. Hydrogen peroxide is a powerful disinfectant useful for cuts and abrasions but when applied to soft ear wax, often it will expand and bubble while filling in the gaps. On the one hand, peroxide is great at penetrating soft wax within the ear, however, the solution and wax have nowhere to go and remains in the ear. So before the patient only had wax in their ear/s. Now they have waxy peroxide residue on top of the wax. All of this is easily removed by delicate and precise micro-suction here at Ear Suction Clinic. Ear Suction Clinic does not recommend using chemist based products but rather natural everyday olive oil. Only use olive oil if safe to do so ( e.g. you have no history of ear drum perforations or have an active ear infections). Most of the time, our experienced Audiologist is able to remove earwax from our patients' ears without prior softening. If you would like to have your ears treated to the best and safest earwax removal procedure, call 1300 380 060 or book online here. Brand New Ears We see a lot of ears here at Ear Suction Clinic and almost always our patients comment how they feel everything is much louder once their ears are professionally cleaned of wax. Of course everything normalises again after a few minutes (or in some cases a few hours) but why is it that we hear things as though they are much louder than we remembered once our ears are unblocked? The same question can be asked of the phenomenon that occurs when you uncover a previously covered eye. The light is too intense at first for our brain to handle. What is happening here? Well, when your ears are blocked with wax, usually there is an associated hearing loss. In other words, all sounds arriving at your ears are attenuated by various amounts depending on the frequency of the sound. The brain is therefore starved of auditory stimulation at an intensity it was previously used to and hence re-calibrates itself to the new norm. Our brain is very plastic in that is will always reorder itself in a way to compensate for change. Once it gets used to something new, this becomes the new norm. Once the wax is removed or the eye is uncovered, the brain's new sense of norm has changed all of a sudden. It needs time to catch up and therefore the new stimulation will appear too much at first. But just as before, the brain can reorganise itself and make the sounds around us normal again with time and stimulation. This acclimatisation process occurs all the time for new hearing aid wearers. If you feel the sounds around you are not as loud as they once were or people are sounding blurry, you may have a hearing loss. Ear Suction Clinic can either clean you ears as well as measure you hearing ability with a thorough hearing assessment.
 Ear Suction Clinic - Grand OpeningThe team here at Ear Suction Clinic are thrilled to offer the people of Perth a safe, thorough and professional ear wax removal service that they don't have to wait months to access. Micro-suction Ear Wax Removal has typically only been offered by ENTs but has been integrated well into the primary health service by like-minded dedicated audiologist or nurse run micro-suction ear wax removal clinics in the UK, New Zealand and the Eastern States of Australia. Why should WA miss out? Ear Suction Clinic is also proud to be offering a comprehensive Tinnitus Management service which includes tinnitus counselling, sound enrichment therapy, tinnitus relief devices and exclusive to Western Australia, TINNITUS LASER THERAPY. To book your ear wax removal or tinnitus relief appointment with a trained Audiologist at our brand new shop in Yokine's DR7 Medical Centre, call 1300 380 060 or book online here. 
MANAGING EAR INFECTIONS IN CHILDREN As a parent and an audiologist who sees children quite frequently, I am only too aware of the over representation of ear infections in the paediatric population -- particularly over the winter months. Children are more prone to ear infections (middle and outer) for a number of reasons including having an immature immune system and Eustachian Tube function, being surrounded by other children who may be sick as well as not being as thorough with personal hygiene .
The Royal Australian College of General Practitioners (RACGP) have recently put forward some guidelines for GPs to take note of the next time they need to decide whether to prescribe antibiotics or not. This is especially important given the rise in concern of anti-biotic resistance. Dr Lynn Weekes, NPS MedicineWise CEO says “Using antibiotics when you don’t need them can contribute to bacterial resistance, both in the individual and the community…the more antibiotics we use, the more chances bacteria have to become resistant to them and as a result they will lose their power.” The RACGP instead recommend a 'wait and see' approach as the majority of ear infections in children resolve by themselves. If symptoms worsen or don't improve with time, then antibiotics (assuming the infection is bacterial) may then be warranted. Interestingly, antibiotics do not reduce the pain associated with ear infections and may even have adverse effects like diarrhoea. Therefore, in the initial 24-48 hours, an analgesia like a paracetamol may be prescribed by the GP. As a parent, it can be very tempting to accept a quick fix to a medical issue involving your child. But what the RACGP are suggesting is to have this conversation with your GP to determine whether antibiotics are indeed necessary. At Ear Suction Clinic, we do not just remove wax. Often we are asked to remove and clean debris resulting from infection of the ear (bacterial and fungal). We are then asked to paint on prescribed drops onto the infected area to ensure they work more effectively if and when they are actually required. This is akin to cleaning up a wound before applying some ointment like when your child falls over and grazes their knee. So next time your child needs to have ear drops with anti-fungal or anti-bacterial properties administered, get Ear Suction Clinic to do it. This has the potential to expediate the healing process. Did you know, ear wax in the right quantity is actually a good thing. It has anti-bacterial qualities great from keeping microbes out of the ear canal. However, unfortunately too much wax can exacerbate annoying tinnitus, cause a hearing loss, impede hearing aid performance, increase the likelihood of whistling hearing aids and exacerbate some underlying ear-related pathologies like otitis externa. Risk factors for impacted wax include:
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November 2018
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"What a relief! Who could have thought wax removed could make such a difference to the way I hear and feel. Best money spent ever." |
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