The ear naturally produces cerumen, commonly known as earwax, a mix of glandular secretions, dead skin cells, and hair. This substance serves a protective function by lubricating the ear canal and trapping foreign particles like dust and dirt. Usually, jaw motion helps move the cerumen gradually out of the ear canal, creating a natural self-cleaning process. If this mechanism fails, it leads to excessive buildup or blockage. When this accumulation causes symptoms or prevents a proper ear examination, it is medically termed cerumen impaction, requiring professional removal.
Determining the Need for Professional Cleaning
A doctor’s initial step involves discussing the patient’s symptoms, which often include a sensation of fullness or pressure in the ear. Patients frequently report reduced hearing, persistent ringing (tinnitus), or a mild earache. Sometimes, the impaction can cause dizziness or a cough due to nerve irritation in the ear canal.
To confirm cerumen impaction, the doctor performs a visual assessment using an otoscope. This device, equipped with a light and a magnifying lens, allows the practitioner to inspect the ear canal and eardrum directly. Visualizing the degree of buildup dictates the choice of the most appropriate removal method. The diagnosis is made when wax accumulation causes symptoms or obstructs the view of the tympanic membrane, which is necessary for a complete examination.
Water-Based Removal (Irrigation) Techniques
One common method for removing soft or moderately firm cerumen is ear irrigation, also called syringing or lavage. This technique uses a steady stream of fluid to gently flush the wax out of the ear canal. The fluid is typically warmed water or a saline solution, as using a solution that is too cold or too hot can induce temporary dizziness or vertigo.
Before flushing begins, the doctor may recommend pre-softening the wax using cerumenolytic drops for several days. These drops, which can contain agents like hydrogen peroxide, mineral oil, or carbamide peroxide, help break down the wax plug, making it easier to dislodge. During the procedure, the water is delivered using a specialized syringe or a low-pressure electronic irrigation device.
The practitioner directs the solution flow along the wall of the ear canal, aiming the stream away from the eardrum. This directional flow pushes the wax outward and minimizes injury risk. The water then flows into a basin held beneath the ear, carrying the dislodged cerumen. This method is avoided if the patient has a known or suspected eardrum perforation, a history of ear surgery, or an active ear infection, as introducing liquid could lead to complications.
Specialized Mechanical and Suction Methods
When irrigation is unsuitable or ineffective, doctors use specialized methods involving physical removal under direct visualization. This approach is preferred for patients with very hard, deeply impacted wax or those with contraindications to water-based methods, such as a compromised eardrum. These techniques require more specialized training and precision.
Mechanical Removal
Mechanical removal utilizes small, specialized hand-held instruments like curettes, loops, or micro-hooks. The doctor carefully inserts the chosen tool past the wax and gently scrapes, curls, or levers the cerumen out of the ear canal. The choice of instrument depends on the consistency of the wax, with forceps being more effective for dry, flaky cerumen.
Microsuction
The most precise technique is microsuction, which employs a miniature, low-pressure suction pump with a fine, sterile tip. The doctor uses a binocular operating microscope or specialized magnifying loupes to maintain a clear, illuminated, and magnified view of the ear canal. This direct visualization allows for targeted wax removal while minimizing contact with the sensitive skin of the ear canal. Microsuction is a safer, water-free option for patients at higher risk of infection or injury, such as those with diabetes or recurring ear problems.