What is the cause of ear fullness (ear flushing)?

From the Guidelines

Ear flushing should only be performed when necessary to remove excess earwax (cerumen) or debris that is causing symptoms like hearing loss, fullness, or discomfort, as recommended by the clinical practice guideline on cerumen impaction 1. When considering an ear flush, it is essential to weigh the potential benefits against the risks, particularly in patients with a history of ear problems. The decision to perform an ear flush should be based on the presence of symptoms such as hearing loss, ear fullness, or discomfort, as these may be indicative of cerumen impaction 1.

Key Considerations

• Cerumen impaction can cause a range of symptoms, including hearing loss, ear fullness, and discomfort, and removal of the impaction can improve these symptoms 1.
• The procedure should only be performed by a healthcare professional or under their guidance, especially in cases where the patient has a history of ear problems or is unsure about the best course of action.
• Ear flushing is not recommended for patients with ear tubes, a perforated eardrum, ear infection, or recent ear surgery, as it may exacerbate these conditions.

Procedure

For a basic at-home ear flush, use body temperature water (98.6°F/37°C) or a commercial ear irrigation kit with a bulb syringe. Tilt your head over a sink, gently pull your outer ear up and back (for adults) or down and back (for children), and direct a gentle stream of water toward the ear canal wall, not directly at the eardrum. Allow water to drain out naturally.

Benefits and Risks

The benefits of ear flushing include the removal of excess earwax and debris, which can help to restore normal ear function and comfort 1. However, there are also potential risks to consider, such as pushing the wax further into the ear canal or damaging the eardrum. Therefore, it is crucial to follow proper technique and seek medical attention if symptoms persist or worsen after the procedure.

From the Research

Ear Flush Methods

• Ear drops can be used to remove ear wax, with various types of liquids available, including oil-based and water-based compounds 2
• The effectiveness of different ear drop types is uncertain, with no high-quality evidence to support one type over another 2
• Ear irrigation can be used to remove ear wax, but it is essential to take a thorough history and examination to exclude contraindications and ensure the appropriate use of equipment 3

Safety and Effectiveness of Ear Flush Methods

• Ear syringing is a common practice, but complications can occur, and it is crucial to follow safe procedures 3
• Softening ear drops may be necessary to help the ear fulfill its self-cleaning function and should be considered first-line treatment 3
• Manual removal with microsuctioning may be necessary in the event of contraindications, complications, or failure of other methods 3

Clinical Guidelines and Recommendations

• Cerumenolytics and irrigation of the ear canal are reasonable first-line therapies for cerumen impaction 4
• Manual removal is appropriate if irrigation and cerumenolytics are contraindicated, but specialized training may be required to prevent adverse outcomes 4
• Family physicians play a key role in the assessment and management of cerumen impaction and should be knowledgeable about available techniques and their contraindications 4

Economic Evaluation and Cost-Effectiveness

• The cost-effectiveness of different ear wax removal methods is uncertain, with limited good-quality evidence available 5
• Softeners followed by self-irrigation may be more cost-effective than softeners followed by irrigation at primary care, but further research is required to confirm this 5