Growing Clamour Over Micro Suction
At Hearing Aid Know we get a lot of correspondence, one email caught my attention a while ago. It was from a chap and it was about damage or injury caused by micro-suction ear wax removal. He said that micro-suction ear wax removal was dangerous and there were many accounts on the web about people’s tinnitus being exacerbated and people losing their hearing. Since ear wax removal has become a major part of our practice, I thought I better take it seriously. When I began to research my answer, I thought that anyone who offers micro-suction ear wax removal needs to know a few things. If you offer micro-suction, you need to read this.
Study Evidence
Two things struck me about his email, the first was that he had obviously spent time researching the subject and had handpicked two studies to back his claim. The first was about general loudness of suction devices in the ear canal and the second was about sound levels being reached during an explosive clearing of the canula. I will talk about them later in the article.
The CE Mark
The second thing was that he stated that micro suction machines being currently used for aural micro suction were not in fact CE marked for the purpose. He said that most of the devices were certified for the suction of liquids and not substances like ear wax. When I looked into that, it appeared that there is only one CE marked “aural” suction device available in the UK which is supplied by Guymark. It is the Otopront VAC system. I need to completely verify that and I will stand corrected if I am wrong.
Not a Huge Amount, But Significant
The email intrigued me so I decided to check out just how many instances I could find of people complaining about damage or injury caused by ear wax removal. I also decided to look at the studies that were out there in relation to micro suction ear wax removal.
It turned out that there weren’t very many people who had complained, at least online. I found some instances but they were relatively limited in number
Deafness or Tinnitus Caused By Micro-suction Ear Wax Removal
There are some studies out there in relation to micro-suction for ear wax removal but not a lot. First I will look at the issues at hand and then I will discuss the studies. We all know that if a patient has pre-existing tinnitus, micro-suction ear wax removal may exacerbate it. While I have always believed that the problem will be temporary, there are people who have reported ongoing problems with their tinnitus after micro-suction.
Onset of Chronic Tinnitus!
There are also people who have reported the onset of chronic tinnitus from micro-suction. There are little statistics to tell us how many and during my searches across the web, I only came across about ten. That is not to say that there are not others out there.
Just How Loud?
We all know that micro-suction is a noisy procedure, but are you aware of just how loud the noise in the ear canal can get? We know that any exposure to noise can cause a temporary threshold shift and normally, that is all it will be, a temporary problem.
Long Term Hearing Loss?
However, some people have reported that micro-suction has caused them a long-term hearing loss. Again, there are few if any statistics and I could only find about six during my searches. This is what I have found out about the studies that are out there and the noise levels of the machines.
In the study Noise levels generated within the external auditory canal during microsuction aural toilet and the effect on hearing: a prospective controlled series a test was undertaken with 14 patients. It was found that in 2 patients the peak noise level in the ear canal was 120 dB which is pretty damn noisy.
However, it was found that none of the patients suffered a temporary threshold shift. In the study Aural microsuction for wax impaction: survey of efficacy and patient perception a study that was undertaken with 159 patients. It was found that although a few people suffered from some pain and or vertigo, “Aural microsuction is well tolerated. Side effects are mild, and the prior use of cerumenolytics appears to further reduce their severity“.
In the study Suction-generated noise in an anatomic silicon ear model it was found that the noise which occurred during the procedure was “Average noise levels during normal suction in a distance of 1 cm in front of the eardrum ranged between 97 and 103.5 dB(A) (broadband noise). Peak noise levels reached 118 dB(A). During partial obstruction of the sucker by cerumen or dermal flakes, peak noise levels reached 146 dB(A).”
They and others refer to the partial obstruction phenomenon as either Clarinetting or the Clarinet Phenomena. There is another study called Suction-Generated Noise Levels During Aural Toilet which was undertaken in Germany. It is perhaps the most unrealistic of the studies, the study was undertaken using water and lard. It found “The suctioning of water generated a maximum noise level of more than 130 dB(LAmax), while the suctioning of lard reached nearly 150 dB(LAmax). The time lapse of both noise and frequency level for lard suctioning was characteristic of a bang”.
This study, in particular, has been quoted online several times to support people’s arguments that micro-suction is inherently unsafe. I think our argument with it is that ear wax is not the same consistency of either water or lard. Another argument I would have is that any professional who is stupid enough to leave the probe in the ear when it is blocked has not been trained to competent standards and needs a slap.
There are cannulas available that have a very small hole in them to control suction levels, not unlike the set up of a hoover. Cover the hole with your finger, maximum suction, uncover the hole the suction abates. This is really useful because as soon as you hear the cannula become blocked, you can uncover the hole and take it out of the person’s ear. In that way, you reduce the patient’s exposure to Clarinetting.
The reason I write this article is that there are people out there using forums to bring up the unrealistic lard study and making claims about hundreds of people who have been damaged by the process. Interestingly though, all of the people who claim to have been injured say it was done by an ENT, no one seems to mention Audiologists.
Considering everything I have found during my research, I think it is clear that you need to protect yourself now more than ever. While I will further research the CE marking of the Otopront device, I think if there is a CE marked suction device for aural suction, well then I would consider getting it. The MHRA says that you can use off label medical devices if there are no other options. If indeed the Otopront is CE marked for aural suction, well then that is no longer a defence.
Great article, we offer micro suction irrigation and clinical wax removal with probably 60-70% being micro suction. with no complaints or issues as of yet(fingers crossed ) the 3 main things we always ensure are 1. information : informing the client of everything the procedures entail including it being noisy and may cause irritation or ringing in ears. 2. potential risk : of ringing in ears and itchiness when cerumen is removed, 3. consent: ensuring the client understands the procedure & all risks and agrees to all of it. and lastly practice: it does not make you perfect but makes you proficient and safe
Thanks for sharing. I have 37 years of experience suctioning ears of all ages and have luckily never had an issue. I will be more cautious and use smaller aperture canulas going forward.
I went for a general ENT check up 2 weeks ago. And the doctor just did microsuction just to clear some ear wax and dead skin without telling me anything. It wasn’t even needed. It was so damn loud. And now I have developed permanent tinnitus in my left ear. What was once a quiet world is now filled with anxiety. My peace and happiness have been taken away from me.
Do you still have the tinnitus today? I got it this same way recently and very worried it’s permanent.
I also got tinnitus this way and have had it for nearly a year.
I had no issues whatsoever with my hearing to start with. Just a build up of wax.
The procedure was carried out by NHS without any explanation.
Whilst my right ear is still as per normal, my left ear has hearing loss and a fullness sensation to the extent at times I feel like I’m being buried alive.
I went to the GP and he offered me nasal spray to see if this might relieve me but no chance. Its been 5 days now, I don’t know how much longer I can carry on this way.
The GP did check my ear as I said I suspected fluid build up (olive oil drops to soften wax).
He said he couldn’t see anything.
I am so distressed and depressed now.
Hi,
There was nothing wrong with my hearing whatsoever.
I went for a routine ear wax removal.
The right ear after was as per normal.
However the left ear has suffered considerable hearing loss and a feeling of fullness to the extent at times I feel like I’m being buried alive.
This was done by the NHS in the U.K. No explanation of the procedure was given whatsoever.
This was done 5 days ago; I want back to the G.P. who prescribed me nasal spray to see if it might help but no good.
The GP checked my ear as i suspected fluid build up (olive oil drops 4 days prior to suction). He said he could not see anything.
Will this ever go back to normal; I don’t know how long I can carry on this way.
Thanks for reading.
My husband went to have his ears syringed, three weeks ago, but they did the suction, ever since his hearing has gone worse, he cant follow a conversation, because he says he can’t hear, worse when he’s in company, caught follow the television, it’s just been a nightmare, he went to see the GP, who said because he’s had a cold, it could be congestion, as he had mucas at the back of the throat, and apparently we have tubes running from the ears to the throat that could be blocked with mucas, so he has been taking decongestants tablets, for three weeks, no change , he is so sorry he had this procedure done, really dont know what to do.
Hi Christine, get him along for a hearing test, it will at least give you an idea about what is going on.
I wish this was informed to everyone and a well known topic.
Normally the ENT i go to is super careful and use suction rarely and it is not so loud.
But yesterday I was at the hospital and the Ear doctor there cleaned my ears up really thurrowly. It was really Noisy, I even got suprised by a really loud bang when the suction got clogged.
Last night my tinnitus(had it for 8 years)got worsened, and it is still much louder than usual.
I wish I saw this article before going to the ENT. I had a cut in my ear canal and the ENT was trying to suction the dried blood off my ear drum. It was the FIRST time I also experienced dizziness too after being suctioned. The ENT never mentioned TINNITUS as a side effect from suctioning. This needs to be ADDRESSED to every ENT to inform the patient. Maybe there would have been another route to remove the dried blood. I wished I also went to someone more experienced. My old ENT wasn’t seeing any patients due to Coronavirus. This ENT was young and cocky. If I learned anything from this, ALWAYS go to an OLDER more experienced doctor too!
I had micro suction a few weeks ago and my ear has been ringing since. Really scared and depressed. I did not understand the risks. The wax was really soft. I had no tinnitus problem prior to this.
i had that, it went away after 2 months. I had a sharp pain during the procedure too but found the machine too loud
How bad was yours? Your tinnitus? Was it constantly there and you couldn’t think or sleep?
I too had micro suction for the first time 2 months ago and now have tinnitus in that ear. I wish I had been aware of the risks beforehand as this is an unpleasant condition to live with.
just came across your insteresting articl. i get very bad wax build up every 4-5 years. i once had it removed with irrigation at the local GP, but this is no longer offered. about 2 years ago i went to an ear wax removal clining in Longfield in Kent but had a very bad experience. They were using microsuction on my right ear then all of a sudden i had an intense sharp pain and instantly had tinnitus, i was shaking and sweating and made the man doing the suctioning stop. i left and never went back, i had tinnitus for around 2 months after that kept me awake and got very loud. it went away luckily after those months. Last year i used home irrigation and oils and cleared my ears enough that i was happy. But this year the wax has come back very bad and both are very blocked, my right ear always seems the worst though, i remember when i had the GP irrigate them said my right ear canal was slightly deformed and curved around a bit, maybe this is what causes the issues. I have been using earol spray the past month but ended up with an infection in my right ear, this may be because of the intense itching and rubbing the outside of my ear with my knuckles. Iv used eardrops for ear infections for the past week that i got from a local walk in hospital but im still getting sharp pains in the right ear. I have so much wet wax in both ears it feels like they are ful to the opening of the canal. Due to my bad experience of microsuction im very reluctant and scared about having that again and want the irrigation method again but am finding it impossible to fine somewhere to get it so may try again myself with the had irrigator from amazon. But would prefer a qualified person to do it and also check my ears. I also found the noise deafening from microsuction and almost unberable. To me its an awful way to do it and seems to have allowed others to open up clinics no matter if they have the skills or not to use the machine.
This topic makes me SO ANGRY!!! Why are patients not informed of the risks of microsuction, and more to the point why is this practice still allowed when it’s clearly DANGEROUS.
I’ve never had any ear issues until 5 years ago I went to an ENT as I had a wax build up in one ear. He suctioned both ears, no explanation about the procedure and certainly no mention of side effects. It was a very noisy procedure. Almost straight away I felt a kind of fullness in my ears. In the following days I developed severe tinnitus, hyperacusis and a sensation that my ears were plugged up. I also had pain in my ears and face. Almost 5 years later and things have not improved, in fact my hearing has steadily gotten worse. I have constant tinnitus, ear fullness, hyperacusis and hearing loss. Before microsuction my hearing was perfectly healthy. It sickens me that this issue is not being addressed, and that so many audiologists and ENTs are performing microsuction without a second thought. It’s time we were listened to and believed, not ignored!!! After reading the other comments it’s clear that in 5 years NOTHING HAS CHANGED!
Oh, I am so angry how could doctors do this to us!!!! They are supposed to help, not to ruin our lifes! I experienced the same: I went to ENT because of a small wound in ear and he said that the ear is clean, but he will clean the dead cells in the canal in order to take sample for microbiology. He used microsuction and it was so loud and uncomfortable, even painful. A told him, but he said that it was normal. He showed me a very small amount of hell yellow wax at the end of the tube. At the evening I got pain deep in my ears. This lasted some days. After a week I got vertigo and nausea that went into dizziness. Then the ears felt full, there was pressure, the hearing was muffled and every sound became painful. The ears started to pop constantly, afterwards I developed tinnitus. Now I ended with trigeminal neuralgia and don’t know how I will live with all this debilitating pain and pressure in the ears. Nobody can help me. I am so sorry that I went to ENT for a harmless wound and ended as an invalid for no reason. I can hardly move my head, because I get pain and dizziness. I can not do anything more, can not live normally.:((((
I came across this article, and have bad experience from ear wax suction in my right ear. The problems appeared just after the “treatment”, and now I struggle with tinnitus/hyperacusis, and sleep problems. I have this “blast” sound in the moment i start to fall asleep. Like a electric “swoosh” sound. All this came right after the wax suction. I asked the doctor if it was damaging, beacuse the extreme high sound, mut he ignored it. Will not recommand this! If someone have tips for me how I can get rid of the high pitch sound when I try to sleep, I will be very happy …
I had microsuctoon 14 days ago and ever since have had tinitus but even worse is the fuzzy hearing. I cannot watch tv as I miss most of what is being said and subtitles are not comprehensive. I avoid meeting people as I cannot make out what is said. People shout but it is clarity not volume that is needed. Is there any chance these symptoms will disappear. I am due to go back to the hearing centre tomorrow but am afraid of what he might do. Do I have any recourse to the law since I was told only that I might have altered hearing for a couple of hours not a couple of weeks or more.
I had a very loud noise exposure about 9 days ago to one ear (had earbud in and a noise on laptop was too loud). All I wanted was prednisolone just in case I suffered acoustic trauma because my ear was aching and was slightly muffled. No ringing. They wouldn’t give me it unless I agreed to have earwax removed. They did my good ear, and I realized it was too loud so I declined. Stupid me, I started panicking at home all worried about taking prednisolone within the first few days as it’s time-sensitive. I went back, they did microsuction, then irrigation, and then an audiogram which showed my hearing was normal. That night the tinnitus started and I feel they ruined my life now. Why is this procedure not banned! Even 1 in 1 million people suffering torture for the rest of their life is too much for a procedure that is convenience only and not necessary! Why is the American Tinnitus Association and other groups that received funding not speaking up about this to hospitals and doctors!?
I can only echo the comments above, there is clearly a problem with the noise levels generated when clarinetting is allowed to happen. I had microsuction 6 weeks ago and have suffered with raging Tinnitus ever since, a high pitched whistle that I can hear above everything, it’s torture. I am a consultant engineer and it has affected my concentration levels. From my understanding the chances of suffering trauma from this procedure is in the hands of the practitioner, if he’s letting the device squeal away inside your ear with little or no consideration (like in my case) then the risks are surely increased. Before the procedure, I had mild Tinnitus in one ear that didn’t bother me, I explained this to the Audiologist and he said nothing, did not highlight any risk of worsening the Tinnitus. I don’t think that this industry is taking this seriously. I am in no doubt as to what caused this unbearable Tinnitus – it’s poorly administered Microsuction. I am sure the professionals will dismiss this and say there is no evidence but I would caution anyone before going ahead with this procedure. If I could rerun this I’d put up with the wax.
This is a great article. In answer to your question about where the patients are for whom microsuction was the cause of their tinnitus, we are absolutely out there. Perhaps we don’t exist in statistically significant numbers yet because it is a relatively new procedure and there simply hasn’t been the intelligence-gathering.
For me, I have no history of ear problems but I was 28 when a bout of inner and middle ear infections meant I went to see my GP. I was prescribed antibiotics and told to get my ears cleared of wax — privately, because this was no longer offered on the NHS. I went to Specsaver’s and booked an appointment and had the wax removed a month after my GP’s appointment. Immediately after the procedure was finished on my left ear, I heard a consistent sparkling sound which I’ve heard ever since. When I complained to Specsaver’s they admitted it was company policy not to perform these procedures up until there months after an infection, but did not uphold my complaint, insisting that what had happened to me was extremely rare. Nearly a year on, I still have this noise. Others in the British Tinnitus Association forum I joined reported the exact same thing after a microsuction procedure.
I think it is often being blithely offered without a comprehensive discussion with the patient’s GP or proper knowledge of their medical history. Even my GP seemed uninformed, insisting that it would subside as I’m young and have no prior history of auricular problems.
I will leave you to imagine how distressing it is when following medical advice lands you with a condition like this.
I had micro suction at Boots last December as my g p said I had a build up of wax in my right ear .However, they did both ears ,and straight away my hearing was really distorted,had a specialist look at my ears ,couldn’t see any damage and couldn’t understand why I can’t hear properly.Feel really depressed as I can’t join in conversations now or listen to radio ,fed up with asking people to repeat things ,just wish I hadn’t had it done ,I was only slightly deaf beforehand,please think twice about this procedure.
Hello Carol Felick can I ask if your ears are any better now ? My husband has just had the procedure and is really suffering as he now can’t hear properly and has been told it will start to get better soon but he’s wishing he hadn’t had it done.
I have just come across this site and am very interested to find that many people have suffered as I did with microsuction. I had it last November 2020 after I had phoned my GP to complain of slight pain in my right ear. Because of Covid, regular appointments were not being made and she simply told me to put olive oil in the ear and then have microsuction. At this stage nobody had even looked at my ear. I asked to book an appointment and was told the NHS no longer handles ear problems ( why not? One of our most vital senses is handed over to muppets) it transpired that one of the practice nurses had just trained in microsuction, thereby creating a business for herself in home visits for the treatment. I was given her telephone number and innocently arranged her visit. She is a very good nurse, amazingly fast at extracting blood from me for tests and I felt confident she would be safe.
She arrived, unpacked her equipment and asked me to sign a piece of paper, which stupidly I hardly read. I presume it was to waive any responsibility if things went wrong.
She started on the right ear and I immediately felt sick with the pain and noise. My husband rushed in from his study on the other side of the house to see what was happening with so much noise. I then felt faint and had to lie down on a sofa. I drifted in and out of a faints drenched in perspiration. She asked my husband to make sweet tea and this helped enough for her to finish the ear with me lying down on my bed. I refused to have the left ear treated and paid her for what she had done.
Immediately I realised my ear was damaged. Sounds were much louder than normal, there was a whistling in my ear as I walked and in the days following I felt dizzy or unsteady all the time. I complained to the GP practice but they very quickly told me it was nothing to do with them. My regular GP looked at my ear but said it all looked fine, I insisted on more help and eventually many weeks later was seen at our local hospital audiology department. They diagnosed age related hearing loss and could not find anything particularly wrong. Eventually I paid to see a vestibular consultant who gave me exercises for the dizziness and unsteadiness and said the ear that was treated had some loss of hearing but she could not necessarily connect it to the microsuction. That is definitely not my view.
I now live with having to do shaking head and walking with eyes closed exercises every day to keep on top of the unsteadiness I feel. If I forget to do them I feel very unwell and unsure of going out alone.
Sorry this is so long but it might be interesting to others. I shall never again have microsuction.
My mum went to hospital to have earwax removed by micro suction. She had deafness in one ear already owing to a previous illness. She came out deaf! This was several years ago and it has not improved. My issue is that this procedure, when there are known risks, should not have been undertaken on a person who already has profound hearing loss in one ear, otherwise the consequences are obvious, which my Mum has found out to her cost. She has a very small amount of hearing but not much, severe tinnitus and what she describes as “dreadful distortion” of sounds so she can’t even listen to any music. She has been back to the audiologist etc but they can offer no explanation and say nothing can be done, not even using tools like bone transmission headphones etc. Can anyone help me? Is there somewhere she can go to get some more help and advice. It makes me so sad that this has happened to her, especially as she loved to listen to music.
Just to add my voice to those who’ve had negative experiences. Mine are certainly not as bad as some who have responded here, but they are unpleasant enough. Needing my hearing aids adjusting because my hearing in one ear was getting worse, I was told (NHS) that I needed a proper wax-removal. Fair enough. During lockdown I was keeping it at bay with Otex, which works, after a fashion. NHS no longer offers irrigation, so I went for microsuction, the word around which is reassuring, isn’t it? Result: a whole clarinet(ting) recital, loss of 20-30% of hearing (I’d say) in my ‘good’ ear, and the bad ear slightly badder. Plus inevitable increase in tinnitus. ‘Temporary’, I was told. But how long is temporary? It’s now 3 months and counting. My hopes are not high. (Will it improve gradually? Will it go pop? Nobody let’s on.) I’ve had significant adjustments to my hearing aids, so conversation is now OK, but music (‘music programme’ notwithstanding), which is important to me, is a problem. And without the aids I am now helpless: not deaf, but in most situations may as well be. ENT told me that the position (shape? disposition? pattern?) of my eardrum is now flatter, less concave than would be expected. Well: to put it bluntly, if it has been sucked out, it will be! Question: if something has been sucked out, why can’t it be blown back? I know membranes are delicate things — but then if I know it, how come nobody ever told the microsuckers the same thing? The audiologist responsible for this shambles (‘HCPC and RCCP registered’, 30 years’ experience in NHS etc etc) reacted to my reference to irrigation with ‘Ah, the bad old days!’ That’s oral clarinetting for you. It’ll be back to Otex for me, while I search for an irrigator for next time. Why would I risk microsuction making me completely deaf?
I have just read these articles. Thank you everyone, I now know I’m not alone. I had ear wax removed by micro suction over a month ago and since then I have suffered from tinnitus and hearing loss in my left ear. The whole experience was terrible but I didn’t expect to leave the room with problems.Everything sounds blurred, it’s hard to hear conversations and I have a permanent hiss in my ear. I feel very depressed and don’t know what to do in future. Syringing always worked fine for me with no problems. How can this be left to go on?
I had micro suction nine months ago and it has ruined my life. I can no longer take part in meetings, watching TV is useless and listening to music is iI mpossible. Sounds are badly distorted or muffled and I feel as though my own voice is trapped in my head. I strongly believe that micro suction should be banned. The medical profession will not admit that there is a prob lem because it is a nice “little earner” for someone.I feel that the NHS will suffer through this as I have had to see several doctors over the past few months and I have had to resort to a private consultation. When will someone wake up to the fact that this procedure is not safe.
Microsuction is the reason why i was able to see comments like this and I am regretting doing it in my right ear
I already have tinnitus in my left ear but it doesn’t disturb me for almost 5 year until it recently got worse that I couldn’t sleep, I went to see a ENT doctor they used water syringe which was the best, the left ear with the tinnitus was successful removed but the right ear which I had no problems with was not successfully removed then the doctor suggest to suction in my right which they did for few minutes yet the wax didnt completely remove I came back and they use syringe few was able to come out this time they use another syringe that forces water into the ear and it was making similar noise like the suction but it was lower.
For some days I wasn’t feeling myself till it got better after some weeks I started having tinnitus in my right ear now I am still under medication from the ENT I will avoid any suction the normal ear syringe is better
The only hope I have is God Almighty that Heal should heal me.