Ear Wax Removal in Hyderabad, India

Earwax doesn’t need treatment as it usually comes out on its own; however, build-up of excess earwax can cause problematic symptoms, so an ENT physician chooses the treatment to remove it. The treatment approaches for ear canal cleaning are classified into different groups, which are listed below:

• Observation
• Cerumenolytic agents (an effective approach for cleaning the ear canal)
• Irrigation or Ear syringing
• Bulb syringing
• Microsuction 
• Dry mopping
• Manual cleaning 

Cleaning the external ear canal can be achieved by using various ways. These can be performed based on age of the patient, presence and location of wax or discharge, the available equipment and the expertise of the medical professional.

Observation:

• As mentioned above, ear wax removal is a natural process in the body. Therefore, an ENT doctor (otolaryngologist) recommends watchful waiting or observation for a period of time to see if the problem goes away or worsens.

Cerumenolytic agents (wax softeners)

• The initial step in treating problematic ear wax is to soften it to check if it comes out by itself and to make removal by an otolaryngologist easier. If softening the wax is unsuccessful, the next step is to visit an otolaryngologist for wax removal.
• Cerumenolytic agents act as first-line therapy, which contains ear drops that break up or soften the wax to encourage normal wax expulsion from the outer ear and help remove it. 
• These solutions can be used alone or generally combined with either manual removal, cleaning or irrigation (in preparation for ear irrigation) or physical removal by an otolaryngologist.
• Wax softeners or cerumenolytics can be divided into three types: water-based, oil-based, and non-water/non-oil-based preparations. 
• Water-based and non–water/–based/non–oil–based agents increase cerumen miscibility (mixability), whereas oil-based preparations lubricate the wax. 
• Water/saline, oil, almond oil, olive oil, or other medical solutions are examples of cerumenolytic agents. These include 3-4 drops of a water-based solution or an oil-based compound, including olive or almond oil drops, for up to 5 days. 
• If the person has excess wax, the otolaryngologist may suggest using olive oil drops to enable the wax's natural motion (movement) from the ear canal.
• A recent Cochrane review found that a 5-day application of active treatments (the agents described above) was best for clearing wax compared to no treatment.
• It is recommended to lie down on the side with the affected ear uppermost and drop 2 or 3 drops of cerumenolytic agents (at room temperature) into the ear canal. 
• Lying on the side for 10 minutes after the oil drops in the ear is suggested to allow the drops to soften the wax. 
• Repeated gentle pressure on the tragus (gently pressing and releasing the small, cartilaginous flap of skin) promotes movement of the drops and disperses wax. Before irrigation, use these earwax removal drops twice daily for at least seven days.
• The current guidelines from the National Institute for Health and Care Excellence (NICE) recommend using cerumenolytic agents for 3-5 days, followed by irrigation if symptoms persist. However, some experiments and research studies have argued that using cerumenolytic agents for more than five days does not deliver any further significant effects or improvements. 

Irrigation, or ear syringing: 

• Ear irrigation is only recommended when ear drops and bulb syringing have failed to work.
• Usually, ear wax removal may be attempted by irrigation of the ear canal, with or without using ceruminolytics (wax softeners), ceruminolytics alone, or manual removal using a forceps, curette or suction.
• Ear syringes are not expensive and readily available. However, some can be slow, poorly balanced, or cause minor ear trauma.
• Ear irrigation involves mild flushing of ear wax from the ear canal with an electronic irrigator or syringe using a stream of warm water.
• Various irrigation methods are available. Self-irrigation can be performed at home, but it is not recommended for patients with frequent ear infections, ear tubes, or a hole in the eardrum. 
• Treatment with cerumenolytic agents for the initial five days (with an agent 15-30 minutes before the procedure) improves irrigation success.
• This is needed to be performed under direct vision; a headlamp assists in visualising the ear canal.
• During the procedure, the patient is asked to sit upright, and the ENT otolaryngologist pulls the pinna upwards and backwards to open and straighten the canal and enable better visualisation.
• The irrigator or syringe tip is inserted into the lateral one-third of the ear canal (no deeper) and pointed in a super direction to prevent direct contact of the water stream with the tympanic membrane.
• An irrigation basin is tightly held below the pinna to catch the water and wax as it flows out. 
• A kidney-shaped dish can be placed under the ear to collect the water overflow. A large syringe can be filled with lukewarm water and firmly attached to a metal or plastic cannula. 
• Ensuring that the water is at body temperature (37°C) is crucial. Otherwise, stimulating the labyrinth (caloric effect) may cause discomfort and vertigo.
• The water jet has to be directed backwards and upward, not directly at the tympanic membrane. Expelled water may be inspected as evidence of wax. An otoscopy should be performed after the procedure to assess the extent of wax clearance.
• Syringing is contraindicated in the presence of discharge or if the patient has history of a tympanic membrane perforation or previous ear surgery. If this is the case, it may be necessary for a specialist to clean the ear canal manually. 

Bulb syringing

• Bulb syringing is the safest alternative way to clear ear wax. which is easily available and allowing people to empty their ears from wax at home. However, this method is not recommended if the person has pain inside the ear, fluid coming out, a hole in the eardrum (perforation), or recent ear surgery.

Microsuction

Ear micro-suction is a dry and safe method for emptying ear wax. It involves removing ear wax using a high-powered microscope (binaural microscope), whether in the form of head loupes (magnifying glasses) or a fixed microscope fitting attached to a suction pipe.

It is indicated in people who do not have water in their ears, particularly if they have 

• Any potential complications from prior irrigation with water.
• Had otitis media (middle ear infection) in the last two months
• Had any ear surgery, a hole in the eardrum, history of mucus discharge from the ear in the last two years and painful ear infection. 

However, adequate and safe cleaning of the external ear canal may not be possible for children and adults with limited cooperation, such as toddlers, and those with mental impairment may require a general anaesthetic. 

Dry mopping: Dry mopping can be done in discharging ear but is not appropriate for cleaning wax or other debris. It may be performed before the insertion of eardrops in a discharging ear. Patients or their families may be instructed to perform this at home as follows:

• Insert and gently rotate the ‘mop’ within the ear canal under direct vision
• Repeat this action with clean cotton wool until it is returned clean or the discharge is removed.

Manual removal

• Manual ear wax removal is preferred in patients with a history of ear surgery, abnormal ear canal anatomy, systemic illnesses that raise the risk of infection, or a nonintact tympanic membrane. 
• This technique must be performed by a healthcare provider under direct vision with adequate illumination using a headlamp, a binocular microscope, or a handheld otoscope.
• This is the best approach for soft wax located close to the external auditory meatus and in the lateral ear canal. 
• Manual removal is often more immediate and involves using a metal or plastic loop or spoon, such as: 
• Jobson-Horne probe 
• Wax hook/loop 
• Crocodile forceps
• Manual removal using a curette is a well-established and effective clearing of the ear canal.
• The instrument is passed deep into the wax and carefully drawn outwards, removing the wax deposit. Avoiding contact with the sensitive ear canal is essential; otherwise, pain and trauma may result. 
• Poor visualization and improper instrument use near the eardrum can also pose a risk of damaging it.
• The procedure requires a patient's cooperation and strong clinical skills to reduce the risk of trauma or injury.