Earwax (cerumen) is produced by cells lining the ear canal and works to protect the ear canal by keeping it clean and healthy. Wax is normally self-clearing but, if there is disruption to the normal movement of wax, it can build up in the ear canal. This build-up of wax can occur for many reasons, including using hearing aids, if cotton buds or other objects are inserted into the ear canal or if there has been previous surgery. Excessive hair in the ear canal can also prevent the easy flow of wax. Build-up of earwax can block the ear canal (impaction) giving a temporary hearing loss and discomfort and can contribute to outer ear infections (otitis externa).
Hearing loss due to impacted wax can be frustrating and stressful and, if untreated, can contribute to social isolation and depression. Wax in the ear canal can also prevent adequate clinical examination of the ear, delaying assessment and management; for example, audiologists cannot test hearing or prescribe and fit hearing aids and doctors cannot examine the eardrum if the ear canal is blocked with wax.
The main approaches to removing earwax include the use of wax softeners (such as olive oil drops, sodium bicarbonate drops, or water) prior to mechanical removal using electronically controlled irrigation of the ear canal (flushing the wax out using water), or microsuction (using a vacuum to suck the wax out). It is not clear which earwax removal approach is the most effective and in which setting this should take place. Currently there is considerable variation in practice; people are inappropriately given ear drops for weeks without effect, irrigation in primary care may not be available and many are referred to ENT services for wax removal. Using secondary care services for earwax removal has considerable resource implications. There is a need for quick, efficient and cost-effective wax removal. This chapter examines the most effective method and the most appropriate setting for wax removal
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