Ear Care

Ear Syringing

“Injury to the ear is frequent with this technique – usually because insufficient care is taken in its execution”,quoted from an ENT text.

Ear syringing is no longer considered a safe practice. If there is an Ear Canal Cleaning service available using a microscope/suction (and fully trained staff) then that is the preferred method for the safe and comfortable removal of debris from an ear canal. Clients should be given the ‘informed choice’ if both services are available BEFORE syringing is performed.

Syringing is a blind procedure, often medical personnel performing the procedure are not skilled with an otoscope, do not have an otoscope with a good white light, do not recognise landmarks or conditions and proceed to squirt water into the ear in the hope that all will work out alright! Sometimes without even looking at the ear canal first!

The negative effects of syringing can lead to complications later – largely unnoticed by health professionals

  • syringing equipment may not be adequately clean and most centres use tap water
  • syringing removes the natural protective waterproof/bugproof layers of the ear canal
  • syringing leaves moist skin = infection risk

Therefore there is a huge risk of ‘medically acquired’ Ear Canal Infection. Dead skin is often left in the canal, after the wax has been dissolved with the water. If the skin dries:

  • it may bounce and make noises
  • if it rubs or touches the ear drum it can cause vertigo episodes
  • it creates a fast growing ‘core’ for a new wax plug

If it remains wet or gets wet (shower/swim):

  • it becomes a ready home for infection – either acute or chronic

Staphylococcus aureus is the most common bacteria that creates an ‘overgrowth’ rather than an infection. It can infect the wax glands and ‘overgrows’ into a puggy, sticky, wax coloured, solid plug with an unpleasant ‘hot sweet’ odour, which if not recognised can be syringed time and time again.

If a person needs syringing less than 6 months after the last episode suspect a curable disorder!

Before ear syringing, the ear canal contents must first be softened. Big hard plugs can be water blasted down the ear canal blocking it, sometimes forced against the eardrum – creating injury, blockage and/or discomfort. Pharmacies now sell a wide range of wax softening drops. Cooking oil is often used too.

Other common mistakes include:

  • water has to be 38 deg C ,using too cool water can cause a vaso-vagal reaction
  • not checking if the ear is empty afterwards (again the quality of the viewers skill is equally as important as the quality of the otoscope), and most surprising of all,
  • not stopping if the client reports discomfort! We have seen a frail elderly lady who had been squirted 48 times in one ear then sent out to drive home on her own to her empty house while in extreme distress with severe vertigo and nausea!

If the client says that they have had anything wrong with their ears in the past, including uncomfortable syringing, then the professional is foolish to go ahead without first retaking the history and making sure that ‘First they do no harm’.

Trauma is an unnecessary side effect of unskilled ear syringing.

Ear drum perforations can easily happen to areas of an eardrum with previous perforations/damage (the middle “strong elastic” layer is missing therefore the drum is very weak). This can only happen when the syringe is aimed incorrectly, straight at the eardrum and not along the roof/walls of the canal. Most will heal on their own but all should be watched and if not healed in two months or if infection sets in must be referred for ENT opinion – with an ACC claim form.

Contra-indications for ear syringing

  • canal lumen patency not proved – exostoses, collapsed canals etc
  • wax not softened for 3 days prior
  • children under 16 years
  • foreign body in the ear canal
  • perforated ear drums
  • person cannot valsalva today, are the ear drums intact?
  • risk of infection – pain discharge, swelling
  • any history of ear trouble or conditions
  • anyone experiencing dizziness, vertigo or tinnitus
  • any history of discomfort or giddiness with previous syringing
  • anyone who does not/can not understand the risks