Question:

What are the latest guidelines on ear syringing for ear wax removal, should we do this in surgery or not?

14 November 2007 note: This question is over 2 years old and may differ to any new research.

CKS (formerly PRODIGY) has a guideline on ear wax [1] that was recently updated.  With regard to the management of ear was removal it states:

“How should earwax be removed?

Prescribe ear drops (e.g. sodium bicarbonate 5%, sodium chloride 0.9%, olive oil, or almond oil) for 3–5 days initially, to soften wax and aid removal.
 - Do not prescribe drops if you suspect the person has a perforated tympanic membrane.

If symptoms persist, consider ear irrigation, providing that there are no contraindications.

If irrigation is unsuccessful, there are three options:
 - Advise the person to use ear drops for a further 3–5 days and then return for further irrigation.
 - Instill water into the ear. After 15 minutes irrigate the ear again.
 - Refer to an Ear Nose and Throat specialist for removal of wax.

Advise anyone who has had earwax removed to return if they develop otalgia, or significant itching of the ear, discharge from the ear (otorrhoea) or swelling of the external auditory meatus, as this may indicate infection.”

Later on in the guideline (about one-third of the way down) is the section “How should I irrigate an ear?” which may be of interest.  This is too large to reproduce here, but it can be read in the guideline or a summary can be viewed below [2]

The guideline also has a separate section on cautions and contraindications to ear irrigation [3] which, again, can be read via the URL below).

References

1) http://cks.library.nhs.uk/earwax/view_whole_guidance
2) http://cks.library.nhs.uk/clinical_summary/earwax_irrigation_how_to.pdf
3) http://cks.library.nhs.uk/clinical_summary/earwax_irrigation_when_not_to.pdf

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