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Is Ear Wax Removal By Microsuction a Safe Procedure?

2019-03-01 100

Asked by J O'Neill on 01 March 2019

Is micro-suction ear wax removal safe?


Answered by Geoffrey Cooling


Micro-suction ear wax removal

In general, ear wax removal by micro-suction is a safe procedure, however, as with any medical procedure, there are things that may go wrong. The risks are as follows:

  • Damage to or infection of the skin of the ear canal or the eardrum
  • The procedure is noisy and may cause a temporary shift in your hearing thresholds
  • The procedure may start or aggravate any existing tinnitus.
  • The procedure may cause temporary dizziness or discomfort

Let's deal with them one by one.

Damage to The Ear Canal or Eardrum

The person undertaking the process will take every care to ensure that the tip of the suction probe will not come in contact with the ear canal or the eardrum. During the procedure, you need to keep very still, if at any time you feel likely to move or to cough, raise your hand to stop the procedure. A sudden movement with a steel probe in your ear canal is probably not a good idea. A sudden movement probably will result in damage to your ear canal or even your eardrum. The professional will always brace their hand, however, bracing only protects from small movements. Having said that, sometimes if the ear wax being removed off the ear canal wall is dried in, it may remove some skin cells with it as it is sucked off. You will feel a pinch when that happens, while it leaves a little graze, it isn't or should not be a major problem. Having said that, most professionals will dose you with olive oil spray to try and ensure it doesn't happen. 

Deafness or Tinnitus Caused By Micro-suction Ear Wax Removal

There are some studies out there in relation to micro-suction for ear wax removal but not a lot. First I will look at the issues at hand and then I will discuss the studies. If you have pre-existing tinnitus, micro-suction ear wax removal may exacerbate it. Normally, the problem will be temporary, but there are people who have reported ongoing problems with their tinnitus after micro-suction. There are also people who have reported the onset of chronic tinnitus from micro-suction. There are little statistics to tell us how many and during my searches across the web, I only came across about ten. That is not to say that there are not others.

As I have said, micro-suction is a noisy procedure and noise within the ear canal can get quite loud. For this reason, most professionals will try to ensure the probe is in your ear canal for the least amount of time possible. However, any exposure to noise can cause a temporary threshold shift (make your ability to hear worse). Normally, that is all it will be, a temporary problem, however, some people have reported that micro-suction has caused them a long-term hearing loss. Again, there are few if any statistics and I could only find about six during my searches. Let's address the studies that are out there and the noise levels of the machines. 

In the study Noise levels generated within the external auditory canal during microsuction aural toilet and the effect on hearing: a prospective controlled series a test was undertaken with 14 patients. It was found that in 2 patients the peak noise level in the ear canal was 120 dB. Which is pretty damn noisy, however, it was found that none of the patients suffered a temporary threshold shift. In the study Aural microsuction for wax impaction: survey of efficacy and patient perception a study that was undertaken with 159 patients. It was found that although a few people suffered from some pain and or vertigo, "Aural microsuction is well tolerated. Side effects are mild, and the prior use of cerumenolytics appears to further reduce their severity". 

In the study Suction-generated noise in an anatomic silicon ear model it was found that the noise which occurred during the procedure was "Average noise levels during normal suction in a distance of 1 cm in front of the eardrum ranged between 97 and 103.5 dB(A) (broadband noise). Peak noise levels reached 118 dB(A). During partial obstruction of the sucker by cerumen or dermal flakes, peak noise levels reached 146 dB(A)." They and others refer to the partial obstruction phenomenon as either Clarinetting or the Clarinet Phenomena. There is another study called Suction-Generated Noise Levels During Aural Toilet which was undertaken in Germany. It is perhaps the most unrealistic of the studies, the study was undertaken using water and lard. It found "The suctioning of water generated a maximum noise level of more than 130 dB(LAmax), while the suctioning of lard reached nearly 150 dB(LAmax). The time lapse of both noise and frequency level for lard suctioning was characteristic of a bang".

This study, in particular, has been quoted online several times to support people's arguments that micro-suction is inherently unsafe. My argument with it is that ear wax is not the same consistency of either water or lard. Another argument I would have is that any professional who is damn fool enough to leave the probe in the ear when it is blocked has not been trained to competent standards. 

In fact, I use probes that have a very small hole in them to control suction levels, not unlike the set up of a hoover. When I cover the hole with my finger, I get maximum suction, when I uncover the hole the suction abates. As soon as I hear the probe become blocked, I uncover the hole and take the probe out of the person's ear. In that way, I reduce the patient's exposure to Clarinetting. I don't believe for one minute that I am the only professional who has been trained to do this. 

In finishing, yes it is a noisy procedure, yes, that noise could cause an exacerbation of your existing tinnitus and if you suffer from tinnitus you need to weigh that up. Yes, as with all exposure to noise, there is a chance that you may have a temporary threshold shift. It appears though that the chances are slim. That doesn't mean, it can't happen. Simply be informed, weigh up the evidence and make your own informed decision.  

Temporary Dizziness

If the procedure goes on too long, it can reduce the temperature within the ear canal. This can produce dizziness, in some people, it can produce full-on vertigo. In some susceptible people, it can turn into something resembling a scene from the Exorcist. Again, this is a very rare occurrence and most professionals will always try to limit the amount of time that the probe is in the ear canal. 

In essence, there are risks, just as there is with any medical procedure. The professional should do everything to reduce those risks though. The professional should also make sure that you are fully informed of the risks. If you have any other questions, please feel free to get in touch. 

2019-03-01 100

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