Syringing (to remove ear wax )

Syringing is contraindicated following recent injury or in patients who have had a perforated ear drum. It is also contraindicated if there is a history of recent otitis externa or otitis media, previous middle ear/mastoid surgery, and if it is the only hearing ear (1). In these cases the patient should not be syringed and should be referred for dewaxing under direct vision (1).

NICE state that (2):

• removal of earwax should be offered for adults in primary care or community ear care services if the earwax is contributing to hearing loss or other symptoms, or needs to be removed in order to examine the ear or take an impression of the ear canal.
• 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

The syringe tip should be blunt and the water used at body temperature (to prevent caloric stimulation of the vestibular apparatus). (1)

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, and failure of wax removal. Otitis externa may also complicate ear syringing.

Note that a study posing the question "can ear irrigation cause rupture of the normal tympanic membrane" (4) concluded that, in a normal tympanic membrane, it was not possible to generate sufficient pressures to cause perforation of the tympanic membrane.

Reference:

1. Pulse (2004), 64 (3), 70.
2. NICE (June 2018). Hearing loss in adults: assessment and management
3. BMJ. 1990 Dec 1; 301(6763): 1251-3.
4. J Laryngol Otol. 1995 Nov; 109(11): 1036-40.