Microsuction ear wax removal

Updated: Aug 15, 2018

What is it?

Microsuction is a method of removing ear wax from an ear canal under a microscopic view using gentle suction.

How does it work?

A thin metal tube, which is attached to a suctioning machine, is slowly inserted into the ear and onto hard wax and the ear wax is pulled out. The lumps of wax are cleared in this way until the ear drum is visible.

What equipment is used?

A microscope or microscopic glasses called loupes are used to enable the clinician to get a really good view of the ear canal.

A bright light is used to allow the clinician to see all parts of the ear canal clearly.

A suctioning machine to provide the force to pull ear wax out of the ear.

A canula or a speculum. This is a small funnel that is put into the entrance of the ear canal. It enables the clinician to get a good view of the wax, it gets the clinician closer to the wax, and the sides of the funnel allow the clinician to work safely within the ear canal.

How do I prepare for microsuction?

Don’t do anything to the wax that will push it further into the ear! The best thing to do is leave your ear and let the clinician have a go at removing the ear wax first.

Technically, it does help to put olive oil in the ear up to two days before your appointment, and the best stuff to use is Earol. The olive oil helps to loosen the dried wax from the skin of the ear canal so when it comes to suctioning it out, there is less wiggling of the wax and less pulling in the ear.

However, it’s not something I would necessarily advise and there are four reasons for this:

1) As soon as you put olive oil into an ear that’s blocked with ear wax, you will feel even more occluded. This is because the oil expands the wax and fills in any gaps you might have had.

2) It’s a bit messy and a bit of a faff. Even with the spray bottle design of the Earol bottle, you can still end up with an oily ear or face.

3) Many patients don’t listen when I say to use olive oil only and will use another ‘wax-softening’ product. In my opinion, most other ear products hinder wax removal and certainly hinder microsuction. Olive oil is the only thing that will safely help and the only thing I recommend.

4) Microsuction works best on hard or semi-hard wax. If the wax is too soft it makes microsuction more difficult, it blocks the suctioning tip and takes longer to remove.

My solution, rather than adding to the misery of a blocked ear, risk using the wrong product, and messing about with oily drops in the ear is to just to have olive oil put into the ear by the practitioner during the microsuction appointment. This way, the correct oil is used, someone is there to help, and any residual oil will be suctioned out and wiped away by the practitioner. Remember, hard wax is fine for microsuction, it just needs to be lubricated so that it slides out of the ear comfortably.

How long does it take?

Guidelines for wax removal recommend working in an ear for up to 15 minutes. So the suctioning process should not take longer than 30 minutes for two ears. If it’s particularly difficult or complicated wax, you may need to be rebooked. Conversely sometimes it can take as little as 3 minutes! It depends on the consistency and amount of wax, and the shape of the ear.

How much does it cost?

Typically it will cost £40 for one ear and £60 for two but prices may be higher in the South of England.

Where can I get it done?

You will usually need to pay privately for microsuction, with the service often found at a local independent audiology clinic such as Ear Mint. Most local GP surgeries and NHS treatment rooms offer irrigation only. ENT employ microsuction as their gold-standard method of wax removal but they will only perform it on non-routine ears. These days, many audiologists are trained in the procedure and there is likely to be one in your local area. If you’re local to Longridge, Preston, then book in with me! Otherwise, try an internet search for microsuction and the name of the place you live.

Does it hurt and will I feel anything?

Microsuction should be painless. You will sometimes feel a slight pulling sensation but overall it’s very gentle. Wax is formed in the outer two thirds of the ear canal, so, providing it hasn’t been pushed further down, all removal-work will generally be carried out in this outer area which isn’t as sensitive as the inner third of the ear canal. This is why I encourage people to book in immediately for microsuction if they block up – as well as imminent relief, you won’t feel as tempted to try and remove the wax yourself if you don’t have long to wait for an appointment. Also, because the procedure is only ever pulling wax out of the ear, it is less invasive than other methods of removal such as irrigation, where sometimes if the wax is too hard it can be pushed around the ear canal, causing discomfort.

You are actually more likely to be aware of the cannula in the ear, rather than the suctioning. This is the funnel used in the entrance of the ear to give better access to the wax, but don’t worry, it only stays in the entrance of the ear canal. My advice is to try and relax and trust your clinician. If you are in discomfort just let them know and they can adjust accordingly or try a different technique.

What are the risks?

There are risks to any medical procedure. While these are highly unlikely to occur, it is good to be aware of them. There is risk of infection with any removal of wax, although it is much greater with the introduction of water into the ear (if irrigation or syringing is utilised for wax removal instead of or in addition to microsuction). Trauma from the suction tip if it nicks the ear canal wall – to avoid this you will be advised by the clinician to keep the head still. There is some evidence that suggests tinnitus can be exacerbated by the noise of the machines, and some suggestion of a possible temporary hearing threshold shift. Dizziness can be caused from head movements, pressure change, or temperature change in the ear. If you have any previous history of these conditions, then let your clinician know.

Microsuction vs Irrigation – as a wax removal specialist, what method do I prefer?

Each of these methods has their place. Microsuction is fantastic for hard, dry wax (i.e. wax in its original form) but it does not work well on wet wax (some wax is naturally wet, but normally it will be this consistency if ear drops have been used). If wax is wet and liquid-y it just ends up blocking the suction tube and this is when I would typically swap to water in the ear to rinse the wet wax out of the ear. But if I can avoid water in the ear, I will, because of the greater risk of ear infection. Microsuction is also safer to use on ears with any history of ear conditions such as operations, perforations, or growths in the ear canal. Microsuction is quicker and less messy too, and far less invasive than irrigation. In my experience, I use microsuction 90-95% of the time, and irrigation for the rest. But it is very rare that I would use irrigation without using microsuction first to suction out the harder lumps of wax. The take home message is that microsuction is the safest and gentlest option but if it is not available to you and irrigation is your only choice, make sure the wax is really, really softened with olive oil first.

As always, if you have any queries or comments, feel free to ask them in the comment section or you're welcome to contact me directly.