technical details

Last edited 09/2018 and last reviewed 05/2023

NICE state that (1):

• consider ear irrigation using an electronic irrigator, microsuction or another method of earwax removal (such as manual removal using a probe) for adults in primary or community ear care services if:
  • the practitioner (such as a community nurse or audiologist):
    • has training and expertise in using the method to remove earwax
    • is aware of any contraindications to the method
  • the correct equipment is available
  • do not offer adults manual syringing to remove earwax
    
    
• when carrying out ear irrigation in adults:
  • use pre-treatment wax softeners, either immediately before ear irrigation or for up to 5 days beforehand
  • if irrigation is unsuccessful:
    • repeat use of wax softeners or
    • instil water into the ear canal 15 minutes before repeating ear irrigation
  • if irrigation is unsuccessful after the second attempt, refer the person to a specialist ear care service or an ear, nose and throat service for removal of earwax
    
    

• contraindications include:
  • recent trauma
  • foreign bodies in the external auditory canal (2)
  • vertigo (2)
  • perforated ear drum
  • recent otitis externa
  • otitis media
  • previous middle ear/mastoid surgery (having miringotomy tube)
  • radiotherapy to the area (2)
  • only hearing ear (3)
    • in these cases the patient should not be syringed and should be referred for dewaxing under direct vision (3)

• complications
  • a study examining ear syringing in UK general practice estimated that the rate of complications requiring specialist referral was about in 1/1000 ears syringed (3):
    • these complications included
      • perforation
      • canal lacerations
      • failure of wax removal
      • otitis externa
        
        
• criteria for referal include (2):
  • persistant severe pain following attempted removal
  • if irrigating with water at body temperature causes vertigo
  • referal should also be considered when there is
    • oedema of ear canal, abnormal anatomy
    • history of tympanic membrane perforation,surgery, radiation

Reference:

1. NICE (June 2018). Hearing loss in adults: assessment and management
2. McCarter DF et al. Cerumen Impaction. American Family Physician. 2007
3. Pulse (2004), 64 (3), 70.
4. BMJ. 1990 Dec 1; 301(6763): 1251-3.
5. J Laryngol Otol. 1995 Nov; 109(11): 1036-40.