Accessing Professional Earwax Removal Services

BBC Sounds, Music, Radio Podcasts Hi, I'm Xing Singh, and I'm Simon Jack, and together we host Good Bad Billionaire, the podcast exploring how some of the world's richest people made their fortunes . And we're back for a new season with a brand new lineup of billionaires. Yeah, global pop icon Beyonce. Hollywood movie director Steven Spielberg. Football superstar Christiana Renalo, anyone? And as ever, we're asking you to decide whether they're good, bad or just another billionaire. That's good, bad, billionaire. Listen first and BBC Sounds . Hello, I'm Greg Foot and welcome to Slice Bread, the show that invest igates the Wonder Products promising to make you happier, healthier, or greener. Each episode we follow the crumbs of evidence to find out if one of your suggested Wonder Products is indeed the best thing since Sliced Bread or Marketing BS and today's suggestion comes from Martin Lazelle from Hampshire. Welcome to the studio Martin. Thank you, Greg. What wonder product would you like us to investigate today? Well, it's ear wax removal and whether you should use the drops, have them syringe or have this micro suction. It's called. I think ear wax fits into the same category as our previous episode on foot fungus . I remember that. It feels slightly gross, but it is a really common issue that affects lots of things. So is a buildup of earwax something that you're affected by? Occasionally, it hasn't affected me seriously, but it's one of these things that happens from time to time. And in the past, I've always used this Otex Eardrops, which after three or four days a year sort of pop and I think it's cured. So you have previously used these products and they have helped. Yes. Of course, it'll be good to go through all the options just in case the issue ever comes back. Yes. Any other methods that you've tried have you tried the syring es or the suction? No, not yet. When I went to an audiologist, she recommended something called sodium bicarbonate, which I'd never heard of. So that's another type of drop. And then this week actually I went for the actual hearing test and she recommended something called ear oil, which is the old olive oil. Olive oil. So you've got it in front of you there isn't it? Olive oil spray. Yes. You haven't tried that one yet? No. Well, I'll be interested to ask the expert about that. You are not the only one who's asked us about ear wax removal products, Martin. Plenty of emails sent in to sliced to bread at bbcot on this subject. Listener Christian says he's seen water jets that are squirted down the ear to dislodge wax. Have you seen those? I haven't. But actually on one of the Otex Drops, they do sometimes provide a squeezy bottle that you can use to syringe your ear afterwards. Listener, Helen mentioned she's seen ear wax scrapers advertised. Listener Katie has tried hoppy ear candles and also seen cleaning sets that come with an app and a camera if you want to be a bit more techy. Well let me introduce today's expert who will not be waxing lyr today. He's here to flush out the facts and give us the inside scoop. He is a professor of audiology at the University of Manchester and an NIHR senior investigator and a former chairman of the British Society of Audiolog y, Professor Kevin Monroe. Welcome Kevin. Thank you, Greg. Nice to join you. First off, Kevin, what is earwax? I heard you introduce it as one of these rather gross subjects, but something like two and a half million people a year have to get earwax removed . So ear wax is a naturally produced substance in your ear canal. Your ear canals about two and a half centimeters long and you have glands in your ear canal that produce the proper term is cerumin, but we refer to it as wax and actually when it builds up in your ear canal, it's a combination of wax along with some of the cells that line your ear canal. There's probably some hairs and some dust and dirt that's caught up in it. Ear wax is great because it does lots of positive things. It helps clean. And it does that by trapping dust and dirt and microorganisms that might result in infections in your ear canal. It has anti bacterial and antifungal properties. And it also lubricates your ear canal so it's not all going to be dry and itchy. If we're meant to have it, why would we want to be removing it? So you'd only remove it if it was building up and causing a problem. If ear wax gathers and blocks your ear canal , it causes a variety of symptoms. The most obvious one is it will prevent you from hearing properly. And although that sounds rather trivial, if you try walking around all day with fingers blocking your ear canals, you realize the impact it can have on your ability to communicate . And some of the other symptoms are when you move your jaw, if the wax has got particularly dry and hard, that can be uncomfortable. That's when you'd want to get it removed. And it might build up in your ear canal because you're producing too much of it or it might just be that the normal mechanism has slowed down the way that it normally comes out of your ear canal. And these things tend to happen as you get older so the wax can get a bit drier. It might also occur if you're putting things into your rear canal like your hearing aid, that may be preventing wax from coming out. I think we might be seeing more evidence that it's causing problems on younger people when they wear earphones that fit down the rear canal. Or of course there are some people who put things down the rear can al that they're not really meant to because they think their canals a bit itchy and they want to prod and broke around. Martin, do any of those symptoms resonate for you? I've got a sort of itchy feeling sometimes in the ear. And you yourself wear hearing aids. I do. I must admit when I take them out, rather gross, you see ear wax on the, I think they call them domes. We've got a great previous episode on hearing aids worth a listen on BBC Sounds if you haven't. Before we go through some of the potential home solutions that you, Martin, and other listeners have asked about. Kevin, if someone went and saw a doctor about this, what might a doctor offer in clinic to remove their ear wax? So the guidance in the UK comes from N ICE the National Institute for Health and Care Excellence. Nice would say first of all you shouldn't do anything about your wax unless it's causing a problem. If it is causing a problem, the recommendation comes in two parts. One part is they say it would be a good idea to soften the wax because that will make it easier and more comfortable for a professional to remove. So the first stage is drops as a pre treatment softener and then a health professional would remove the wax from your ear canal and there are different ways of removing the wax. We have tools where we can manually remove the wax. We have irrigation systems that gently allow water at body temperature to flow into your ear and wash the wax out your ear canal, or we have suction machines which are like a hoover that will just suck the wax up. We were looking through the GP guidelines for ear wax removal written by a certain professor Kevin Monroe. Don't trust anything he says. We saw you wrote that while NICE, as you say, National Institute for Health and Care Excellent, recommends micros ion for earwax removal, little is known of the safety of micros cion, and there are reports of dis comfort and minor bleeding. Well, I think if you're seeing a health professional, all the methods are pretty safe, but they come with an element of risk. The microsuction because it's like a hoover, it really depends how hard the wax is as it tugs at your ear canal. So it can cause minor problems, but it's pretty rare that it's going to cause any serious problems if it's done with a hearing professional who has the right expertise in training. But just a question, you talk about health professionals , is there any sort of qualification or can I set myself up as an EWAX removal specialist? Well, that's a good question, Martin. If you're a button entrepreneur, then indeed you could. One of the concerns right now is that you used to be able to go to your GP or your health center and that's where you'd have the wax removed. That's becoming more difficult. So people are having to look around and go into the high street. And there is a concern right now that almost anyone is able to set up on the high street and provide this service. And until it's regulated and there's work being done right now and I'm involved in some of that. The best advice is if you're going to the high street, you can just ask the person if they've got a health background then probably they've been through all the appropriate training. Well, let's go through some of the products that you can pick up in a supermarket or a pharmacy. Martin's got three or four on the desk just in front of him. Let's start with the drops and the sprays that you've just mentioned, Kevin. Martin, you first use the Otex Express eardrops. I've always used that . We've seen these in little bottles around six pound thirty from boots. Yep. The key ingredient looks to be urea hydrogen peroxide. What is that Kevin? First of all, it's worth saying drops and spray areers just a different method for getting the softener into your ear canal. The one that you mentioned has hydrogen peroxide in it. That's something we use around the house for bleaching and cleaning purposes. The way it works is the peroxide mixes with the wax, it releases oxygen, so it causes the wax in your ear canal to bubble and foam, which can be quite impressive if you're able to hear it. And the idea is that that should loosen the wax, soften it and break it down so that it's more easily taken out of your ear canal. And in terms of how to use those drops, you're told to tilt your head to the side, squeeze in five drops, leave them for a few minutes and then wipe with the tissue and you do that once or twice daily for three to four days after which you should notice a reduction in ear discomfort. Did you follow that to the team Martin? Yes, excellent. Kevin, they're marketing this is something that's supposed to get rid of ear wax buildup on its own because they say it reduces the need for syringe and microsucion. But are you suggesting that you use this as a precursor to a treatment with a healthcare professional? Yes, that's right, it's a pretreatment software. And there is a bit of a myth and some confusion about this. The evidence and again it's quite old is that it's only in a small percentage of people. Maybe one in five, the softeners would be enough to dislodge the wax. You may be lucky, but for most people, that won't be sufficient. Martin, you brought in another one that says sodium bicarbonate eardrops. We've seen these available from the brand Care for around four pounds fifty a bottle from high street pharmacies, although they seem to be much cheaper online. Kevin, sodium bicarbonate is baking soda, isn't it? Exactly. You probably have it in your kitchen because you use it when making bread or even sliced bread. Sodium bicarbonate. Now it doesn't work like the peroxide. It doesn't release oxygen but ch,anges the property of the wax and it's meant to make it easier for it to be dislodged and removed from your ear canal. There's a third type of drop that you've got over there in front of you, Martin. Olive oil, you can get bottles like Otex, olive oil ear spray available for six pound fifty from boots containing quote medical grade olive oil. Kevin, how is medical grade olive oil different from the stuff that you put on a salad? The medical grade is telling you that it's been refined or purified to try and remove some contaminants. The olive oil you put in your salad is not necessarily sterile. So the medical grade means there's less chance of it causing any problems, any infections, for example. Could you cause yourself a problem if you go and get normal extra virgin olive oil and put that in your ears instead. Well, I've had people write to me to say I find it cheaper to go to the supermarket and buy olive oil and I share it with my salad and my ear canal. It wouldn't be recommended by NI.CE I don't know if there are many people who had many problems with it, but I think you want to look after your body and not cause any problems. You won't be using olive oil drops that often and it's a very small quantity so I think I would stick to the medical grade one. So OTEC say that their olive oil air spray softens and lubricates hardened earwax to clear ears naturally and that using it may avoid the need for syringe stroke microsuction. So again, they're making this claim here that you don't need to then go do that afterwards. So olive oil, there's no chemical reaction. It's not like with the peroxide or the sodium bicabinet. It's just there as an oil to soften the wax and make it easier to be removed. For a small number of people, the drops in their own might be enough just to dislodge the wax, but for most people that w,on't be enough on its own. I should say there are on all these bottles a long list of precautions and potential side effects. Both the OTX hydrogen peroxide and the olive oil earspray say they can make the symptoms of excessive ear wax worse , including some discomfort, irritation, or pain, temporary loss of hearing, dizziness, and tinnitus. So can using these drops or sprays backfire on you, Kevin? Well, I think the problem is you're putting something into your ear canal that blocks it you.' Sove got the wax bl ock in your ear canal and then you're adding drops that's going to block your ear canal even more. So any hearing difficulty you've got can potentially be exacerbated in the short term until the ear wax is removed. There are some people who get minor irritations from using naturoxide or even the sodium back the drying in the irritation, that would be relatively uncommon and they're usually very mild and minor. What I should just mention at this point is you shouldn't be putting any sort of drops in your ear if there's a chance that you've got an infection so you,'ve got a painful ear or some smelly discharge, or if you've had a history of having a hole in your ear drum, you definitely wouldn't want to be putting drops into your ear canal then. Right. Interestingly, among other precautions on their olive oil spray, O TEC say do not use if you are also putting anything else in the ear such as a hearing aid. Martin did you spot that? No, Kevin, why is that? I think it's probably just a precaution so you don't damage your hearing aid, you know what I mean? The hearing aid is not made for filling up with oil. So I think that's the only reason. But of course, that's not very helpful because you're wearing a hearing aid because you have a hearing problem. You're got even more of a hearing problem because your ears fully waxed. You're going to put drops into your ear canal and then they say and don't wear a hearing aid. So most people don't like that idea because you don't want to go day after day after day without wearing your hearing aid if you can help it. And Kevin, if someone did want to go for one of these drops, is there any evidence that one type of drop or spray is more effective than another? No, I wouldn't say there's currently good quality evidence to guide you down one route versus the other. The evidence is that using drops in general is helpful. We're not particularly sure how frequently should you use it because some people might have more tortuous ear canals, the wax might be harder in someone's ear canals. So the normal guidance and the one from ICE is that you should be putting drops in your ear daily for a few days before you go to your health professional to have it removed. But there's not much evidence just to be clear that one type of drop is better than the other. We also saw that you, Kevin, wrote in your GP guidelines, that saline, salt water, or plain water may be useful and no better or worse than these drops. So is there any point in buying one of these little bosses at all? Could you just use water that comes out of the tap? Some people do, it's not recommended by nice and that's not necessarily because there's a problem. It's just that there isn't much evidence to do it. Some of the studies that have compared the different treatments, comparing a drop with a spray with olive oil, they have used saline or salty water and there's not very much difference. Let's stick with water because there are some of these devices designed to spray water into your ear to get the ear wax out. Kevin, you said that doctors might use this method. it What' looks like in the clinic when you're using water? Traditionally , it used to be a metal syringe and someone would squeeze the water down your ear canal, but that's no longer recommended. Nice have said don't do that because for example, if you're not giving the syringe it can have a lot of pressure and that could potentially damage your ear. So there are alternatives and these are really like little reservoirs of warm, comfortable temperature water that just flows gently into your rear canal and as the water comes out it, carries the wages out of your canal. Listen to Christian emailed us because he's been getting bombarded by adverts for ear cleaners that seem to work in a similar way to what you're describing, but for him to use at home. He says they squirt a water jet down your ear to dislodge wax and they claim that it is more effective and safer than cotton buds. We must talk cotton buds in a second. Looking at a range of these water squirting devices, some look like syringes, they're long, they're thin, they're small, but you can also get these devices that they look like a water bottle with a spout attached. For example, the Kaljick upgraded ear wax removal kit just under twenty quid on Amazon that they say uses a soft, flexible silicon tip. Kevin could, you use these at home devices to irrigate out your ear wax? Well, NICE doesn't recommend the use of them, but that's primarily because there isn't good quality evidence. And having looked into it, I don't see much evidence that there are adverse events. But currently no one's done studies of high enough quality for us to say is this good or is it bad? So I would not recommend that people irrigate their own ears with water just now. Are there risks here as well? Could you damage your eardrum? Well, I think that would be one of the concerns. Well, just like you can get home irrigation devices, you can also get at home micros ion devices. We saw an ear wax vacuum removal kit on Amazon that looks like a tube with a nozzle on the end. It describes how it works as quote, the rotating head and vibration function vibrate the inside of the ear , lifting and sucking up trapped ear wax like a vacuum cleaner. Kevin, what's your take here? I don't think there's any evidence to support these claims. I think the technical term for this is bologna. Noted . What about things that are designed to go into your ear canal to physically scrape the ear wax out? Kevin, I want to ask you about the humble cotton bud, the OG when it comes to removing ear wax. Now, on the products themselves, they don't suggest you use them for removing ear wax, but it's something that a lot of people, including myself do. Is it recommended? It's so tempting to put a cotton bud or some other pointed object into your ear canal, but there are a couple of problems with that. The first is you might just push the wax further down into your ear canal and if you push it down further it, will stay there long er and get harder and set like concrete. The second reason is if you're not an expert know about the anatomy length of your ear canal, you may just do some damage by scraping the side of your ear canal or pushing it right down to where your eardrum is. So I mean cotton buds are used. We used them when we had babies just to get any mop out of a bowl of your ear, but you definitely shouldn't brew it down your ear canals. So Greg, you and others shouldn't be doing it. I say never put anything in your ear that's smaller than your elbow, I think it's a quote. Noted . Well, you did however say that one of the inclinic treatments that is offered is using a special scoop to remove the ear wax. I believe it's called a Jobson horn probe, is that correct? Yes, a Jobson horn probe. So that's what an ear professional will use. Listener Henry pointed us to the Latusio ear cleaner, available for just a fiver on Amazon, looked to be a set of seven stainless steel earpicks, essentially seven different long thin spoons with different sized heads. And they say, quote, The earpick is scoop shaped, so it can remove the ear wax easily and effectively. Kevin, what do you think of those? An ear professional. They're looking down your ear canal and they'll be very familiar with what the typical length and shape of an ear canal is. The sort you can buy on the internet, mostly you're doing it blindly. Some of them say you can do it with a camera and this can work with an app that you put on to your smartphone. But I could quite easily imagine the damage that could cause that you're using some sharp pointed object. You're putting it down your ear canal. You're not particularly familiar with the anatomy of the ear canal or where the benzik are. Some are better quality cameras than others. Some of them they heat up at the end so you can get a burning sensation and also it's difficult to know what the orientation should be. Have you got it right up? So there's no evidence to support their use and they're potentially very dangerous so they definitely are not recommended for home and self use. Listener Katie said that she's used hoppy ear candles. You can buy ear candles at shops like Holland and Barrett. For example, the Bayo sun traditional ear candles come in packs of three pairs for just under twenty pounds. You can also get a pack from the Natural Ear Candle Company for a little under ten pounds that provides instructions to light the candle, then holding it upright, place the bottom gently on the ear canal to hold it there for ten minutes. I should say that these candles don't actually claim to be able to remove ear wax, but that is what a lot of people use them for. Kevin, how are these then supposed to work? Allegedly the heat from the candle, first of all, it melts the ear wax. And because these candles are mostly hollow bit like a chimney actually, the melted wax gets sucked up, the funnel and it just comes out the chimney and disappears into the ether and actually there have been studies carried out and confirm that this is bologna again. The pyrotechnics can be fun of course you might set fire to yourself or to your house. My top tip would be save your money and if you really want a candle for your house, buy a nice scented one. Right. Before I put the final question to you, Kevin, I want to touch on something that a number of our listeners have included in their emails. They've said that people are buying these home solutions because it can be difficult to get access to ear wax removal at the doctors. Listener Henry pointed this out in a voice note that you sent in our WhatsApp number zero seven five three three hundred six eight zero seven. Hi, Greg. I've seen a number of products promising to remove ear wax, and they all claim to be wonderful. But doctors, nurses, and audiologists all insist that you should never insert anything into your ear because you might cause injury or infection. However, many GP surgeries have stopped offering ear syringe. Is there anything that can help? Thanks. Thanks, Henry. Kevin, what are your thoughts about this? So Mice who provided the guidance that we're all meant to follow say that EWAX management should be provided by the National Health Service in your local community . Now historically GPs were provided with a contract to look after all their patients and they would do blood tests or remove earwax or whatever was required, but a couple of things have changed. Health funding for local populations come from these bodies called the integrated care boards and they're under a lot of pressure and they have to prioritize how they're going are to use the fund ing they've got. And for a lot of them, they don't prioritize removal of ear wags. And I think it's partly because of this mistaken belief that the sprays and drops on their own is going to be sufficient for most people. So what tends to happen is there's this belief that you should use drops of sprays and if that's not enough, then you'll get referred onto probably a hospital based service, maybe an emotion and throat department or the audio department. And the problem with that is it might result in a really long waiting time . And also it's probably not good use of the expertise and the professional's time in a hospital environment. So the RNID have a campaign to bring this to the attention of MPs to say this should be provided locally . the me Inantim e, you have no choice but to go to somewhere on the high street and pay to have the wax removed. And just be careful because it's somewhat unregulated right now. Make sure the person is a health professional of some sort or an ear expert that knows what they're doing and avoid the ones that don't. Thank you, Kevin. Yes, we saw that the RNID, the Royal National Institute for the Deaf, have their campaign around this. And they say, quote, there is no medical reason for withdrawing vital ear wax removal services , the ongoing cuts are having a profound impact on people's well being. They also pointed out that attempting to remove earwax yourself can lead to serious complications such as permanent ear damage or hearing loss and that private removal is unaffordable for many. Can I just mention that when I saw the audiologist she recommended using that earrol spray once a week whether you've got a problem or not just to keep it soft and softened? Could that help Kevin? I don't think there's much evidence to suggest that. I mean, ear wax is a normal natural produced substance and we really want a little bit in our ear canals. I think the exception might be if it's someone who has a recurring problem then maybe keeping it soft with an occasional drop of oil would be beneficial. But I wouldn't be recommending that people do this routinely. I think it's time for the final question, Kevin, which I'm going to do is a two party if I can. So firstly, are drops and sprays that promise to soften and remove earwax the best instincts like spread or marketing BS? I think a product that soften ear wax are as a group beneficial and should be used. I don't think there's any evidence to show that one type is any better than another. For most people, there's evidence that the drops and sprays will soften the ear wax. It won't necessarily remove it, but it'll make it easier and more comfortable when it does need to be removed. And secondly, what about these products that you can use to manually remove ear wax? The scrapers, the picks, the at home syringe, the suction kits , any of them the best instant sliced bread or are they all marketed BS? I think there's not enough good quality evidence to support any of these self help home solutions. So I'm with NICE and saying we can currently be recommending them. So anyone who says that there's evidence then they're talking the brown, smelly stuff and I'm not talking about ear wax here . Martin, the final word goes to you, as always, if ear wax becomes a problem for you again, what do you think you'll do? I think I'll probably use the olive oil spray which is the less invasive of all the options and then go to a high street shop and get it removed because I assume that boots and spec savers of the other companies have only used qualified professionals . Well, with that, I shall wrap up this episode of Sliced Bread. A big thank you to Martin and Kevin for joining me. And if you are listening to this and thinking, Greg, I have a wonder product I would really like you to investigate, please do send it over either on email to sliced dot bread at bBC. co. uk or as a message or a voice note on WhatsApp two zero seven five six eight seven. Next time we are talking sauna science, particularly infrared saunas. You might have seen them on your social media, promising to improve your circulation, help you lose weight, even lead to you living longer, all while being more comfortable and convenient than a traditional dry sauna. Are they effective? I'll be finding out. See ya . This episode of Sliced Bread was researched by Phil Sansum and produced by Kate Holdsworth and me, Greg Foot. Our studio managers were Helen Williams and Ben Cuthbertson. Sliced Bread is an audio north production for BBC Radio four . Some events have far reaching consequences. The white noise