Microsuction vs Water Irrigation for Earwax Removal:
Which Is Right for You?

Microsuction and water irrigation remove earwax in different ways. Microsuction uses a fine suction tube while the practitioner views the ear canal under magnification. Water irrigation uses a controlled flow of warm water from an electronic irrigator to move wax out of the ear canal.

Both are recognised methods of earwax removal. The most suitable option depends on the condition of the ear, the position and consistency of the wax, your symptoms and your previous ear health.

What is microsuction?

Microsuction is a dry method of earwax removal.

The practitioner examines the ear and uses magnification to maintain a clear view of the ear canal. A small suction tube is then positioned against the wax so it can be removed without introducing water into the ear.

The suction equipment produces noise, which can sound loud because it is being used inside the ear canal. Many people tolerate this well, but it may be uncomfortable for someone with troublesome tinnitus or a strong sensitivity to sound.

Microsuction is often considered when water irrigation is unsuitable. That does not mean it is appropriate for every ear. Previous ear surgery, perforation, grommets, vertigo, tinnitus affected by noise, recent infection or previous problems during earwax removal should all be discussed before treatment.

What is water irrigation?

Water irrigation earwax removal uses an electronic machine to introduce a controlled flow of warm water into the ear canal.

The water is directed towards the wall of the ear canal or the wax, rather than directly at the eardrum. The equipment regulates the water pressure. The temperature of the water must also be carefully controlled because water that is too warm or too cool can cause dizziness.

Modern electronic irrigation is not the same as traditional manual ear syringing.

NICE advises that manual syringing should not be offered to adults. Electronic irrigation uses equipment designed to regulate the water pressure and is one of the methods that may be considered for earwax removal.

Wax softening treatment is important before irrigation. NICE recommends using a wax softener either immediately before the procedure or for up to five days beforehand.

Is microsuction safer than water irrigation?

There is not enough good quality comparative evidence to state that microsuction is always safer or more effective than water irrigation.

Both are established methods of earwax removal. Both also have possible risks and circumstances in which they may not be suitable.

The safety of either procedure depends on several factors:

• The health of the ear canal and eardrum
• Previous ear surgery or infections
• Whether there is a perforation or grommet
• The position and consistency of the wax
• Whether the person can keep their head still
• The practitioner’s training and competence
• The equipment being used
• Whether the procedure is stopped if it becomes painful or unsafe

When might microsuction be considered?

Microsuction may be considered when:

• Wax can be clearly seen and safely reached
• A dry removal method is preferred
• Water irrigation is unsuitable
• The wax is positioned where suction can be used safely
• The person can remain still during the procedure

Hard or compacted wax can sometimes be uncomfortable to remove. A wax softening product may be recommended before the appointment to make removal easier.

Microsuction should not continue if the wax cannot be removed safely or the procedure becomes painful. Another method, further softening or an appropriate referral may then be considered.

When might water irrigation be considered?

Water irrigation may be considered when:

• The ear is suitable for water based treatment
• The wax has been adequately softened
• There is no known contraindication to irrigation
• The person can sit upright and keep their head still
• The practitioner has suitable electronic equipment and training

Water irrigation may be unsuitable where there is a perforated eardrum, a grommet, certain previous ear surgery, a recent infection or discharge, troublesome vertigo or a history of serious complications during previous irrigation.

These questions form part of the assessment. They are not a substitute for examining the ear.

Can you have microsuction with a perforated eardrum?

A perforated eardrum changes how earwax removal should be approached.

Water irrigation is generally avoided when an eardrum is known or suspected to be perforated because water may pass beyond the ear canal.

Microsuction earwax removal is sometimes considered when water must be avoided, but it should not be assumed that every perforated ear can be treated routinely with suction. The position and condition of the perforation, the health of the ear and the practitioner’s scope of practice all matter.

Some people may require manual removal or assessment by a specialist ear service.

Always report a current or previous perforation before any earwax removal procedure.

What are the possible risks of microsuction?

Microsuction is commonly carried out without significant difficulty, but it is not risk free.

Possible effects include:

• Temporary discomfort or pain
• Grazing or irritation of the ear canal
• Minor bleeding
• Dizziness
• Coughing caused by stimulation inside the ear
• Temporary changes in tinnitus or sound sensitivity
• Rare infection
• Rare temporary changes in hearing

The suction equipment can sound loud. Tell the practitioner before treatment if you have severe tinnitus, sound sensitivity or have previously experienced problems following microsuction.

You should also tell the practitioner immediately if the procedure becomes painful or makes you feel unwell.

What are the possible risks of water irrigation?

Possible effects of water irrigation include:

• Temporary discomfort
• Dizziness or nausea
• Irritation or grazing of the ear canal
• Infection
• Pressure related injury
• Coughing caused by stimulation inside the ear
• Temporary tinnitus or changes in hearing

The water must be kept close to body temperature and introduced at regulated pressure. Irrigation should not continue if it is painful or the wax cannot be moved safely.

Do I need to soften the earwax before treatment?

Follow the instructions provided by your ear care practitioner.

For water irrigation, NICE recommends using a wax softener either immediately before treatment or for up to five days beforehand.

Softening may also make microsuction more comfortable when wax is particularly hard or compacted, although the advice can depend on what is found during the assessment.

The NHS suggests olive oil or almond oil as possible self care treatments for earwax. Almond oil must not be used by anyone with an almond allergy.

Do not use ear drops if you have a perforated eardrum unless a suitable healthcare professional has specifically advised you to do so.

Is water irrigation the same as ear syringing?

No.

The term ear syringing is still commonly used, but modern water irrigation is carried out using an electronic irrigator that regulates the water pressure.

Traditional manual syringing uses a handheld syringe and does not provide the same level of control. NICE advises against offering manual syringing to adults.

Can both methods be used during one appointment?

Yes, where the assessment shows that this is appropriate.

Earwax can vary within the same ear. More than one method may be used during an appointment when this is clinically appropriate. The choice should be based on the examination, relevant ear history and the practitioner’s training and scope of practice. Manual instruments may also be used when the wax is clearly visible and within safe reach.

The method should be chosen according to the ear, rather than making every person fit one standard procedure.

What should happen before earwax removal?

Before treatment, the practitioner should ask about your symptoms and relevant ear history. This may include previous ear surgery, perforations, grommets, infections, discharge, tinnitus, vertigo and any previous problems with earwax removal.

The ear canal should then be examined before a method is recommended.

Sometimes the correct decision is to stop, allow more time for the wax to soften or recommend further medical assessment. Earwax removal should not be forced simply to complete the procedure in one visit.

A blocked feeling or change in hearing is not always caused by earwax. If no wax is present, another explanation for the symptoms may need to be considered.

When should hearing loss be assessed urgently?

Do not assume that a sudden change in hearing is caused by earwax.

NICE recommends immediate specialist assessment for hearing loss that develops suddenly over three days or less and began within the previous 30 days, unless an obvious external or middle ear cause has already been identified.

Seek appropriate medical advice rather than booking routine earwax removal if you have:

• Sudden or rapidly worsening hearing loss
• Significant unexplained ear pain
• Blood or discharge coming from the ear
• Facial weakness or altered sensation
• Persistent or recurrent vertigo
• A known foreign object in the ear

Which earwax removal method should I choose?

You should not have to choose without an examination.

Microsuction and water irrigation are both accepted methods of earwax removal when they are carried out by an appropriately trained practitioner using suitable equipment. Neither method is right for every person, and neither should be described as completely risk free.

The most appropriate method depends on your ear health, the position and condition of the wax and what is found during the examination.