Professor Martin Burton looks at the evidence for ear drops to remove earwax and some things to think about, including whether they need to be removed. Professor Burton is an ENT doctor and author of the Cochrane Review on Ear Drops for Earwax Removal.
When is earwax a problem?
Earwax is normal . It is produced by glands on the outside of your ear canal. For most people, most of the time, it’s not a problem . But not always. Typically, the wax comes out, along the ear canal, into the ear cavity; It does not produce any symptoms and does not ’build up’ in any way.
But if it builds up to the point of blocking the ear canal , it can cause some degree of deafness . If there is a lot of it, it is hard, and it completely fills the canal, it is sometimes called "impacted" wax . In any of these circumstances, or if the wax is causing symptoms of pain or discomfort, it is probably worth doing something to try to remove the wax. Another reason to want to do this is if you are simply blocking the view of your eardrum. Sometimes a health care professional needs to see the eardrum to help make a diagnosis. If there is too much wax in the ear canal, they may not be able to do so, hence the need to remove the wax.
How is earwax removed?
Softening the wax with ear drops may be enough to allow the natural elimination processes to occur so that the wax will leave the ear on its own. Just as it should do. Therefore, if time permits, simple softening and a "wait and see" approach may be sufficient.
But if this doesn’t work , or there is no time to wait, your pharmacist or GP may suggest removing the wax. This is usually done by a healthcare professional. In these circumstances, they will often suggest that you use drops first (at least for a few days) to try to soften the wax before removal takes place. There are several benefits to this; It may lead to you not needing to remove it at all, or it may make wax removal easier.
Various liquids can be used as ear drops, including oils (almond or olive) and oil-based compounds, water-based compounds, or water alone.
Ear syringe with water
When we talk about “having your wax removed by a health professional ,” what do we mean? Previously this involved a healthcare professional spraying warm water into the ear with a large syringe. The goal of this was to remove the wax. But this system could only work in certain specific circumstances. The idea was that the stream of water from the nozzle of the syringe would pass over a piece of wax, hit the eardrum, bounce off the eardrum, and then, as it exited the ear canal, the stream of water would take the wax with it.
It is obvious from this description that two things are of critical importance. The first is that there has to be a space between a piece of wax and the walls of the ear canal. Otherwise, the stream of water simply pushes the wax in and that can be a problem. Second, the eardrum must be intact and normal. If there is a hole in the eardrum, or the eardrum is missing completely (as can happen), the stream of water simply passes through the hole and the patient may end up with an ear infection . Although syringes were once frequently inserted, usually by a nurse or primary care doctor, there were always problems and potential risks associated with it. As a result, it is not done frequently today, but can still be effective if done carefully and safely by an experienced operator.
“Micro-suction”
The main alternative to the syringe is often called "microsuction" or "suction cleansing" . Using a special suction cup and some type of magnification (either a large microscope or a special set of magnifying glasses) with the patient lying or sitting, a healthcare professional will suction out the ear wax. They may also use very fine instruments to lift or remove it.
There is general agreement that this may be easier to do if the wax is softened with ear drops first. Therefore, you may be asked to use drops for a few days before doing so. Like most things, this procedure must be done carefully, with good quality equipment by someone properly trained and experienced in doing it. In those circumstances, it can often be done without undue pain or discomfort and without causing any damage to the ear canal or eardrum. But even in the best hands, it can be messy and the skin in your ear canal can rub.
All hospital otolaryngology departments have the equipment and skills to perform microaspirations , but not all are able to offer the service to the general public. Some GP practices also do this and, increasingly, it is offered by private providers (sometimes in association with the provision of hearing aids).
Making a choice about treatment?
What are the benefits, the risks, the alternatives, what do I want and what happens if I do nothing ?
What are the benefits of using ear drops and how do the different types compare?
The evidence in our Cochrane review suggests that using something other than water when you have a partially or completely blocked ear canal can help remove wax. But it’s not clear whether one type of drop is better than another, or whether drops containing active ingredients are better than plain or salt water.
What are the risks of ear drops?
Any treatment can have unwanted effects.
Not many people who participated in the research studies had any unwanted effects from the ear drops, and these were mild, such as slight irritation or pain or an unpleasant odor. From time to time we encounter a patient who is sensitive or allergic to any of the chemicals contained in some drops. This is more likely when the drops contain active compounds or preservatives. So this doesn’t happen with simple water droplets.
What are the alternatives?
Trying to remove ear wax by inserting objects (including cotton swabs) into your ears can push the wax deeper and damage your eardrum. Ear swabs can cause serious injury (and there is no evidence that they are helpful).
What are your preferences?
If you’ve used ear drops before to soften ear wax, you may want to use the same thing again or try something different. Cost and availability may also be relevant.
What happens if you don’t do anything?
In our Cochrane review, we found no evidence to tell us whether using water or saline (salt water) was better than doing nothing.
*Evidence comes from this Cochrane review: Aaron K, Cooper TE, Warner L, Burton MJ. Ear drops for the removal of ear wax . Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD012171. DOI: 10.1002/14651858.CD012171.pub2.
Authors’ conclusions Although several studies have attempted to evaluate whether or not one type of cerumenolytic is more effective than another, there is no high-quality evidence to draw a firm conclusion and the answer remains uncertain. A single study suggests that applying ear drops for five days may result in a higher chance of complete wax removal than no treatment. However, it is not possible to conclude whether one type of active treatment is more effective than another and there was no evidence of a difference in effectiveness between oil-based and water-based active treatments. There is no evidence to show that using saline or water alone is better or worse than commercially produced cerumenolytics . Likewise, there is also no evidence to show that using saline or water alone is better than no treatment. |
