This factsheet is for people who want to find out more about ear wax and ear syringing.

Transcription

1 Ear wax

2 Ear wax This factsheet is for people who want to find out more about ear wax and ear syringing. Most people have some wax in their ears it s a normal substance that helps to keep the ears clean and healthy. However, if you think that ear wax is actually blocking your ear canal or affecting your hearing, you may need to have it removed. This factsheet explains what ear wax is, how it can cause problems and how you can get wax blockages removed. If you would like this factsheet in Braille, large print or audio format, please contact our helpline see front page for contact details. Contents What is ear wax? 2 When does ear wax need to be removed? 3 Who is at risk of problems caused by ear wax? 4 What is the link between ear wax and tinnitus? 4 What is the link between a wax blockage and hearing loss? 4 Should I try to remove a wax blockage myself? 5 How is an ear wax blockage removed? 6 Are there links between ear syringing, tinnitus and hearing loss? 7 What is the impact of wax on hearing aids? 9 Where can I get further support? 9 What is ear wax? Ear wax is a normal substance that is made up of: dead skin cells a wax-like substance (cerumen) produced by the sweat glands in your outer ear canal an oily substance (sebum) produced by glands in your outer ear canal various other substances, such as dust particles and cosmetics. Ear wax helps to keep your ears healthy: it cleans, lubricates and protects the lining of the ear canal (this links the outer ear with the middle ear). Ear wax, Action on Hearing Loss Information, August 2013, v3 2

3 As it is involved in the natural cleaning process of the ear, ear wax usually works its way out of the ear by itself, without you noticing. When does ear wax need to be removed? Some people produce excess ear wax that can become impacted (compressed) in the ear canal, causing a partial or complete blockage. This can lead to the following symptoms: hearing loss (this is the most common symptom) blocked ears earache itchiness tinnitus (noises in the ear(s) or head see page 4) vertigo (a spinning sensation) though not all experts agree that wax can cause this cough. If you have any of these symptoms, you should see your GP. If it is confirmed that the symptoms are the result of an ear wax blockage, a nurse or doctor will remove the excess ear wax. You may also need to have ear wax removed if: you are having your ears examined and ear wax is preventing the audiologist (a specialist who deals with hearing and balance problems) or doctor from viewing your ear canal and ear drum you are getting a hearing aid and the audiologist needs to take an impression of your ear for the earmould you wear a hearing aid and ear wax is causing it to whistle. In the UK, it is estimated that 2.3 million people each year have problems with ear wax that need intervention. Ear wax, Action on Hearing Loss Information, August 2013, v3 3

4 Who is at risk of problems caused by ear wax? You are at risk of problems because of ear wax if you: have narrow or deformed ear canals have many hairs in your ear canals have a skin disease of the tissues surrounding the outer ear or scalp produce hard wax, as this is more likely to become impacted are older (ear wax tends to become drier) have a history of recurrent impacted wax have recurrent inflammation of the outer ear and ear canal (this is known as otitis externa) have a history of exposure to water, as this causes ear wax to expand work in a dusty or dirty environment wear earplugs a lot or wear a hearing aid this may interfere with the natural process of skin and wax moving out of your ear, causing a build-up of wax try to remove ear wax using an object such as a cotton bud (see Should I try to remove a wax blockage myself?, page 5). If you think that you may have a wax blockage, ask your GP or audiologist to check your ears. What is the link between ear wax and tinnitus? Tinnitus is the word for noises that some people hear in one ear, both ears or in their head, which do not have an external source. The noises can be buzzing, ringing, whistling, hissing and other sounds. To find out more, see our Tinnitus range of information (see Free support and information, page 9, for details). If you have tinnitus and your ear gets blocked with wax, you may notice your tinnitus more. Once the blockage is removed, your tinnitus should return to its previous level. This may take from a few days to a few weeks. If you were not aware that you had tinnitus, the wax blockage may reveal a very mild tinnitus noise that you had not heard before. This normally goes away once the wax blockage has gone. What is the link between a wax blockage and hearing loss? A wax blockage may give you mild, temporary hearing loss. For this to happen, the wax has to completely block the canal or press on the eardrum. Ear wax, Action on Hearing Loss Information, August 2013, v3 4

5 Some people ask their GP to syringe their ears (see page 6) again and again, because their hearing is not what it used to be. In most instances, they do not have any wax blockage to remove. If you often have difficulty hearing the television or radio, or you miss words in conversation, you may have hearing loss caused by a condition in the middle or inner ear, rather than excess wax in your ears. Your GP should take a look in your ears, and if there s no wax blockage or other obvious cause for your hearing loss, they should refer you for a hearing test. Should I try to remove a wax blockage myself? No. If you think you have a wax blockage in one of your ears, ask your GP or audiologist to check your ears. If you try to remove ear wax yourself, you risk damaging your ears and your hearing. Never poke anything into your ear canals You should never insert anything into your ears to remove wax (such as a finger, cotton bud or towel) as this can: damage the wall of the ear canal and cause inflammation cause the wax to be impacted by pushing it further into the ear perforate (tear) the eardrum. Do not use ear candles Ear candling is an alternative medicine practice that involves lighting one end of a hollow candle and placing the other end in the ear canal. It is claimed that the procedure removes ear wax from the ear by creating a vacuum. However, medical research has shown that this treatment is both dangerous and ineffective: it does not help to remove ear wax and may result in serious injury. Take care with ear drops We recommend that you only use ear drops that your doctor or ear specialist has prescribed, unless you go for an alternative option such as olive oil or almond oil (see box overleaf). This is because some types of wax-softening drops that you can buy over the counter may actually irritate your ears and cause otitis externa (inflammation or swelling in the ear canal) when used continually over long periods. Ear wax, Action on Hearing Loss Information, August 2013, v3 5

6 Important: Never use any type of ear drop if you know or suspect that your eardrum is perforated (torn), unless directed by your doctor, as some types can harm the inner ear and even lead to hearing loss. It s often difficult to tell if your eardrum is perforated if you are in any doubt, do not put any drops into your ear and visit your GP. Olive oil and almond oil Research suggests that the use of olive oil or almond oil can soften ear wax and help it to work its way out of the ear. You should use 2-3 drops of olive oil or almond oil per day in the ear that is blocked. There is also an olive oil spray available that delivers a measured dose of oil into the ear canal. We recommend using wax-softening products for 3-5 days only, to prevent any further ear blockages. Again, if you think your eardrum is perforated, do not use these treatments. If the wax blockage doesn t clear by itself, contact your GP to have your ear examined. There are also other ear drops available that your GP may prescribe, such as sodium bicarbonate, but only use these as directed by your GP. How is an ear wax blockage removed? Ear syringing Ear syringing (otherwise known as ear irrigation ) is the method of washing wax out of the ear canal once it is soft enough. Your doctor may prescribe you ear drops for 3-5 days before you have your ear(s) syringed, to soften the wax and aid removal. A clinician, usually a nurse, carries out the procedure, most often using a pulsed water-jet system. This involves a short flow of warm water being passed into your ear canal. The action of the water behind the wax will bring the wax out into a container. A nurse will take a look in your ear before and after syringing to check the condition of the ear. You may find that some medical practitioners still use a metal or chrome syringe, which looks like a small bicycle pump. The metal syringe also uses water to try to move the wax and clear the ear. However, the use of a metal syringe is no longer a recommended method, as it is much less controlled than using a pulsed water-jet system, and it has been known to damage people s ears. Before syringing takes place, make sure you find out what method will be used to syringe your ears. If they are planning to use a metal syringe, you should ask for the pulsed waterjet system instead. You should also feel free to get a second opinion. Ear wax, Action on Hearing Loss Information, August 2013, v3 6

7 It is important that before you have your ears syringed, you let the doctor or nurse know if: you have had ear infections or injuries to your ears you have had surgery on your ears in the past you have tinnitus or hearing loss you have a weak or perforated eardrum previous ear syringing was not straightforward you have any anxieties or questions about syringing. This will help them choose the most suitable wax removal option for you. Other ways of removing wax A doctor or nurse using a dry suction clearance method, wax hook, curette (a scoop-shaped surgical instrument) or probe can also remove wax. This is usually only done in an ear, nose and throat (ENT) department of a hospital, and the nurse will normally look in your ears before and after the procedure to be safe. The suction clearance method is the only method of wax removal appropriate if you have one of the following: perforated eardrum(s) previous ear operation(s) structural abnormalities of the ear canal. You may find that alternative therapists suggest using ear candles to remove wax. There is no evidence to suggest that they work they could actually be dangerous (see page 5). Are there links between ear syringing, ear problems and tinnitus? Unfortunately, very little research has been done into links between ear problems, tinnitus and ear syringing. But in the vast majority of cases, having your ears syringed to remove a wax blockage is a painless, harmless and highly effective procedure. If you have a slight hearing loss and a wax blockage is the problem, it likely that your hearing will return to normal once it has been removed. However, it is important to remember that your hearing loss or tinnitus might not be the result of a wax blockage, but could be caused by something else. Ear wax, Action on Hearing Loss Information, August 2013, v3 7

8 Some medical practitioners feel that ear syringing should not be carried out unless strictly necessary. Some people claim that their tinnitus either started or was made worse after having their ears syringed. However, research suggests that when the ear has been damaged by syringing, it is more likely to have been caused by medical practitioners who have not carried out syringing correctly and/or have failed to get a full medical history before syringing. If the correct syringing technique is carried out on healthy ears, it should not lead to tinnitus or make existing tinnitus worse. Possible causes of problems Poor technique for example, if the water is directed at your eardrum, not at the roof of your ear canal. Faulty equipment for example, if the nozzle of the metal syringe is not checked before use, it could come off during syringing. Failure by the person carrying out the syringing to get a full medical history, to examine you properly or to ask you about possible complications for example, a doctor or nurse should not syringe your ears if you have inflammation of the middle ear (otitis media), if you ve had a chronic middle ear disease or a perforated eardrum in the past, or if you ve had ear surgery. You should say if you have had any ear problems before they start the syringing, not afterwards. Very rarely, the tip of the syringe can scrape the skin of the ear canal this can be painful and very occasionally can cause an infection of the skin in the ear canal (otitis externa). If you think syringing has not cleared your wax blockage If your ears have been syringed and you do not feel that the wax blockage has cleared, go back to your doctor and discuss it. Your doctor may: advise you to use ear drops for a further 3-5 days and then return for further ear syringing place water in your ear and syringe it again after 15 minutes refer you to an ear, nose and throat specialist to have the wax removed. In a very few cases, ear syringing may not be effective in removing wax. Ear wax, Action on Hearing Loss Information, August 2013, v3 8

9 What is the impact of wax on hearing aids? If you wear hearing aids, it s very important to make sure that your ears are not blocked with wax. This is because if the wax blocks the ear mould or ear tip by going into the tubing, it can block off the sound and cause you to think that the hearing aid has stopped working. It can also cause your hearing aid to whistle. If you think that the tubing of your ear mould is blocked, make an appointment at your audiology department to get the ear mould re-tubed. The slim tube and tip can be cleaned or replaced when needed. Where can I get further support? Action on Hearing Loss Free support and information We produce a wide range of free publications covering many aspects of hearing loss and tinnitus. Our leaflets provide introductory information, while our factsheets go into more detail. To find out more, and to order, call our helpline (see front page). Alternatively, you can download our publications at Connect online Share experiences, support and information with others through: Our online forums: Our Facebook page: Twitter: Specialist products We sell a range of equipment for people with hearing loss and/or tinnitus. Visit our online shop at or request a copy of our Solutions catalogue by contacting our Customer Services team directly: 1 Haddonbrook Business Centre, Orton Southgate, Peterborough PE2 6YX Telephone Textphone Fax solutions@hearingloss.org.uk Ear wax, Action on Hearing Loss Information, August 2013, v3 9

10 Other organisations British Tinnitus Association (BTA) The BTA campaigns for better services for people with tinnitus, has a range of publications and online information, and produces a quarterly magazine, Quiet. Ground Floor, Unit 5, Acorn Business Park, Woodseats Close, Sheffield S8 0TB Telephone Fax info@tinnitus.org.uk Acknowledgements The original version of this factsheet was produced with the advice of Philip J Robinson FRCS, FRCS (Otol), Consultant Adult and Paediatric Otolaryngologist, Department of Otolaryngology, Southmead Hospital, Bristol; and Anthony Wright, Professor of Otolaryngology, Institute of Laryngology and Otology, University College London. References All of our information is based on up-to-date research. For a list of references for this factsheet, please references@hearingloss.org.uk We welcome your feedback If you have any comments or suggestions relating to this factsheet, or if you re interested in joining our Readers Review Panel, we d love to hear from you. Your honest feedback will help us to improve our information. To find out more, or to provide us with your comments, please reviewpanel@hearingloss.org.uk or write to Information and Publications, Action on Hearing Loss, Featherstone Street, London EC1Y 8SL. Action on Hearing Loss Information, August This factsheet will be reviewed and updated in August The Royal National Institute for Deaf People. Registered Office: Featherstone Street, London EC1Y 8SL. A company limited by guarantee registered in England and Wales No , Registered Charity Numbers (England and Wales) and SC (Scotland). Ear wax, Action on Hearing Loss Information, August 2013, v3 10