Health $ Lifestyle

Why you must NEVER use a cotton swab to clear out ear wax: Ask the GP DR MARTIN SCURR

As many people are only too aware, impaired hearing isn’t just about finding it tough to hear the TV or respond to a telephone call — it can make social interaction difficult (how many times have I heard patients and friends complain that straining to hear became such hard work they just stopped going out?), and may even be a life-and-death issue.

Think of the shock we all feel when about to cross the road and an electric car, bicycle or scooter is quite suddenly almost on top of us, unheard.

That’s what people who are hard of hearing experience whenever they leave the house. But imagine if that burden could be relieved in an instant, because the problem is actually a build-up of wax?

This used to be something you could trundle off to your GP or practice nurse to sort out. But not any more. Even though every year more than two million people have troublesome ear wax, syringing to remove impacted ear wax is a service that’s no longer routinely offered.

This is because since 2019, syringing has been withdrawn as a service: I blame the GMS committee, the negotiating committee of the British Medical Association, which agrees terms of service for GPs and fights for fees for all sorts of activities that GPs are expected to provide, who can’t have fought hard enough for this service.

This is despite the fact that even back then, the National Institute for Health and Care Excellence — the body that decides which services are available on the NHS according to cost and benefit — referred to the hearing loss caused by ear wax as ‘frustrating and stressful’, adding: ‘If untreated, it can contribute to social isolation and depression.

As many people are only too aware, impaired hearing isn¿t just about finding it tough to hear the TV or respond to a telephone call ¿ it can make social interaction difficult and may even be a life-and-death issue

As many people are only too aware, impaired hearing isn’t just about finding it tough to hear the TV or respond to a telephone call — it can make social interaction difficult and may even be a life-and-death issue

Even though every year more than two million people have troublesome ear wax, syringing to remove impacted ear wax is a service that¿s no longer routinely offered

Even though every year more than two million people have troublesome ear wax, syringing to remove impacted ear wax is a service that’s no longer routinely offered

‘Providing earwax removal closer to home, in primary care or community ear care services, will prevent the inappropriate use of specialist services.’

Now the service is available in only limited circumstances, for example if the patient is in severe pain due to infection and the GP cannot see the eardrum due to accumulated wax.

In my view, this demonstrates that doctors who spend their time in medical politics, arguing over fees and payments, have lost contact with what their colleagues — busy treating sick patients — have to deal with on a daily basis.

A stubborn build-up of ear wax can cause significant problems, including hearing loss, which is why, quite rightly in my view, the RNID, the national hearing loss charity, is campaigning to reintroduce the NHS ear wax removal service.

Ear wax is secreted by glands in the skin that line the ear canal; it acts as a protective barrier against germs and debris, and as it is produced, the older wax gradually migrates to the exterior where it’s easily washed away.

But in some people, this mechanism is faulty — wax builds up and eventually blocks the ear canal. All GPs have patients who regularly — every few months or perhaps every year or so — need their ears cleared of wax.

READ MORE: Paper clips, toothpicks and CANDLES: The ‘dangerous’ ways people are trying to get rid of their ear wax 

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Not to do this puts the patient at risk of at least three problems. The first is difficulty hearing — according to a 2022 survey by the RNID, 73 per cent of people had hearing loss as result of ear wax, and 37 per cent had tinnitus.

The second hazard is infection: if water from the bath or shower, or swimming, enters an ear partially blocked with wax, it can become trapped, which results immediately in near-complete deafness.

Untreated, it can rapidly lead to infection (the warm, moist environment is an ideal breeding ground for bacteria), which may be painful and potentially serious.

Removing the blockage is important because it means you can see inside the ear canal and diagnose what’s going on — if there’s an infection, for instance, the ear drum may appear red and swollen, not shiny and white as normal.

Treatment with antibiotics is also needed as these infections can be very difficult to eradicate. In some, albeit rare, cases, middle-ear infection can lead to perforation of the eardrum and even sepsis or meningitis (the infection can burst in towards the brain), which I have seen on more than one occasion.

The third — and possibly the most common — threat from blocked ear canals is damage caused when the patient tries to unblock their ears themselves: I’ve seen the results of DIY attempts using everything from a cotton bud to a bent paper clip.

As well as damaging the sensitive lining of the ear canal, worse, they may perforate the ear drum (again, not uncommon). The perforation doesn’t always heal properly, resulting in long-term impaired hearing — think of a tambourine with a hole in it, the membrane can no longer vibrate to pass on sounds to the hearing nerve.

As wax can be ‘glued’ to the skin of the ear canal, anchored by tiny hairs, doctors deal with it first using drops to soften it, then flush it out with water, using a device very similar to the ‘Waterpik’ jet dentists use. Or it can be sucked out using microsuction (a bit like a mini vacuum cleaner).

In some instances, I would use a wax hook. But all these techniques require exact knowledge of the anatomy — and awareness of the risks.

The advice now is that people try using drops to shift the wax themselves, using softening drops bought from a chemist.

This can help in some, but not all, cases: in the same RNID survey, 20 per cent of the respondents who tried to remove wax themselves were successful and one in ten said their symptoms got worse or they caused themselves an injury.

Many people end up going to one of the string of commercial organisations that offer to remove ear wax for a fee (around £60).

These are subject to checks on premises and staff by the Care Quality Commission, but not everyone who could benefit will be able to locate, get their way to or afford the service — and I do worry about the understanding of the practitioners involved.

Withdrawal of ear syringing is a great example of a short-term gain leading to longer-term pain.

My view is we must bring this important part of healthcare back under the care of the NHS — and quickly.

Was wax to blame for my hearing loss?

By Dr Michael Mosley 

One of the really annoying things about getting older (I’m 66) is that I often struggle to hear conversations in crowded places.

If I’m in a restaurant or bar with my kids, they can be happily chatting away, but I’ll only catch around one word in three, and end up just smiling and nodding — which is rather depressing and isolating.

Hopefully you’re not reading this over breakfast, because I discovered recently that part of the problem is ear wax. I had a hearing test and after looking in my right ear, the audiologist sucked a blob of wax the size of a raisin out of it.

I hadn’t realised it was there, which is probably a good thing, as the audiologist firmly warned me about ever trying to pry wax out with a cotton bud, as you can end up just shoving it further down the ear canal, leading to all sorts of problems (see Dr Scurr above).

In fact, in my case, removing the wax didn’t make a lot of difference. But then I went into a soundproof booth and put on headphones for a proper test — this involves listening to sounds of different volumes and pitches and pressing a button whenever you hear something, however faint.

'It turns out I have significant hearing loss, particularly at higher frequencies, which explains my difficulty picking out voices where there¿s a lot of background noise', says Dr Michael Mosley

‘It turns out I have significant hearing loss, particularly at higher frequencies, which explains my difficulty picking out voices where there’s a lot of background noise’, says Dr Michael Mosley

My results weren’t terrible, but they weren’t great: it turns out I have significant hearing loss, particularly at higher frequencies, which explains my difficulty picking out voices where there’s a lot of background noise.

This is common as you get older, and can also lead to you missing alerts on your phone or the doorbell. Birdsong may also become just a memory.

As many as 51 per cent of Brits report that they find conversations with background noise difficult to handle, and over a quarter of us (28 per cent) are unable to hear the TV or radio properly, according to a new survey by Specsavers (where you can have a hearing test for free).

But despite these warning signs, most of us have never had our hearing tested.

Why does this matter? Not being able to hear is both isolating, and bad news for your long-term health.

A study of more than 430,000 Brits, published in the Lancet Public Health in April, found that people with significant hearing loss were 42 per cent more likely to develop dementia.

The good news is this same study showed that using a hearing aid removes that added risk. I don’t need one quite yet, but I will certainly get one when I do.

Dr MOSLEY is working with Specsavers to encourage people to think about their hearing health.

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