Possible dangers of Micro-suction

[oldskir]

In the last few days I have sent e mails to my local MP, and to the Government's Health Secretary and the Labour and Lib Dem Health spokespeople.

This is about my concerns over the removal by many GPs of water irrigation to clear excess ear wax, and my worries over the possible dangers of the procedure of microsuction.

I am posting on here a copy of the e mail. To be honest, I'm just hoping someone, somewhere who is in a position, and has the power, to do something, takes some kind of beneficial action.

Dear Mr. Javid,

I am currently contacting a number of MPs, and organisations such as the RNID, to pass on some of the concerns I have regarding services for the removal of excess ear wax. I have asked my local MP to pass my views on to the Department of Health. But as I have contacted your 2 political shadows, I am also sending my comments direct to you as well.

It is fair to say that many people in the UK require to have a build up of excess ear wax dealt with and removed on a regular basis. This problem affects older people in particular. Quite a few of them are reliant on hearing aids to be able to hear, and a build up of wax can mean the aids don't work correctly.

I think with regard to ear wax removal, there are 2 separate concerns. One is clearly the withdrawal by some GPs of a water irrigation treatment/ service ( often referred to somewhat mistakenly as syringing). I do believe that removing ear wax removal as a core GP service was a mistake, and I wish that you would consider re-instating it. The second issue, which is my immediate concern, is the increasing use of micro-suction, which I believe can in some cases cause/exacerbate tinnitus and may cause some hearing loss . A particular worry I have is that GPs no longer providing the gentler method of water irrigation is pushing more people towards having to have micro-suction carried out at a private provider, and I now believe that micro suction can be a more dangerous and risky procedure.

Please let me share with you my own recent experience:

I had a significant setback in the summer. My ears seem to get waxed up pretty quickly, and for over 20 years I have had them water irrigated/ syringed annually. However, due to Covid, my GP wasn't offering that in 2020. By July 2021, I had been 2 years with no wax removal, and my right ear got very blocked, the worst I have ever known. So in desperation, I went to an audiologist, and paid to have microsuction carried out in both ears. Now this seems to be done with no problems for many people, and for me it certainly did get all the wax out. But I found the procedure incredibly noisy, and particularly traumatic in my left ear, which has moderate tinnitus. It was like a deafening, screeching sound down in the ear canal, close to the ear drum. Anyway, the end result is it has made the tinnitus in my left ear worse, and my right ear, which had only very slight tinnitus before, is worse as well. Added to this my ears have somehow felt weird ever since, a bit like everything has been squeezed or pinched, also a slight feeling of light headedness and being a bit unbalanced. Unfortunately, the woman who did the left ear went at it hammer and tongs, more respite breaks might have helped. It is galling, you go seeking help for a medical problem and things happen which make it worse, not better.

(I would point out that I have never had any problems with the water irrigation method, as done by the nurse at the GPs. This is far less noisy than microsuction, and nothing like as stringent on the ear canal.)

My quality of life has been significantly reduced following this procedure nearly 6 months ago. Each day is a constant battle now against the ringing in my ears and the anxiety and depression that this causes. Some people across the world have suffered even more devastating consequences caused by micro-suction. Some say damage from micro-suction has destroyed their lives.

As an example, one person has posted the following on tinnitustalk.com/threads:

Blue28 has written:

Tinnitus Since:04/2016

Cause of Tinnitus:Acoustic Trauma from Microsuction

"I would like to raise peoples' awareness about the dangers of microsuction, and that this is not an entirely safe method of wax removal.

In April 2016 I had wax removed in both my ears by microsuction. During the procedure there was extended periods of very high pitched whistling, which I now know to be called "clarinetting". It happens when the suction tool is blocked by either wax or dry skin. I didn't know that this sound should not have been happening, I wasn't informed about any dangers. This caused a not negligible permanent threshold shift in my hearing over several frequencies. I now have hearing loss (essentialy high frequency) high pitched and very loud tinnitus, ear pain and hyperacusis. My life has been ruined by this procedure.

I was not made aware of the dangers of this procedure by the ENT who carried out the microsuction procedure.

This is apparently rare (although I have read other reports on the internet when people state they have hearing loss due to microsuction), but it DOES HAPPEN...It happened to me.

PLEASE BE AWARE THAT MICROSUCTION CARRIES RISKS, I WAS NOT INFORMED AND HAVE SUFFERED IRREVESIBLE DAMAGE DUE TO THIS PROCEDURE."

Ok, so my main gist is that I believe something needs to be done to bring microsuction under proper/better regulation. It seems that it is increasingly being offered at places like Specsavers, and many audiologists and private "clinics".. When you look at their websites, they present micro-suction as being the best thing since sliced bread, and usually no mention is made that it is a noisy procedure, and that it can indeed cause irreparable harm in some instances.

They usually present a skewed picture of the pros and cons of microsuction as against other methods of removal. In particular, they often try to blur the old style use of a large metal syringe with the more modern method of using a water irrigation machine with a tube and nozzle.( No one would recommend the old squirting syringe any more, but NICE themselves have recommended that water irrigation can be used as a perfectly satisfactory method)

I believe at a minimum that all non NHS providers of wax removal should

1.Be properly licensed.

2.Be required to present more balanced information in their advertising. (Eg do more to point out the risks of the different procedures, particularly those associated with micro suction. Also to stop the mischievous practice of conflating syringing with water irrigation, when they are two quite different and distinct methods,

3. Be required to point out to/remind clients prior to the start of the procedure that microsuction can be noisy and is not without risks.

4. Be required to check whether the client has pre-existing tinnitus, and give a specific warning that the microsuction procedure may make this worse.

5. Be required to ensure all staff carrying out the procedure are fully trained to a certain standard.

6. Only ENT grade equipment to be used.

7. Require a Consent Form to be signed.

8. Make the client aware that they should ask the member of staff to halt the procedure at once if they find it has become too loud. This would allow a short respite break before continuing.

9. Be encouraged to offer to customers a choice of either microsuction or water irrigation.

10. Have an easily accessible Complaints Procedure in place, and make clients aware of it during their visit.

11. There is also the issue of inspection of services that should be considered.

I do wish some MPs would take this issue up, before more people get their ears and hearing permanently damaged. Tinnitus, once caused, is incurable, and I can vouch from personal experience it is a debilitating condition.

I really wish that you as Health Secretary would take an interest in this important topic.

Thank you so much for reading this long e mail. Any help would be greatly appreciated.

Best Wishes etc

[CDPO16]

I attended a NHS ENT clinic for microsuction of ear wax on a regular basis pre covid. There was no warning of the risks involved prior to the treatment. The clinic stopped at the beginning of the pandemic and hasn't restarted yet. I have had tinnitus for many years but microsu tion doesn't seem to have worsened it although it is worse than it was originally.

At some stage I will need wax removal again and may have to go privately to an audiologist but your post is thought provoking and I hope that the MP takes notice and responds in a positive way.

Some years ago the senior partner at my GP practice talked of reinstating ear syringing at my surgery when I was struggling to get an appointment at any health centre in my area. He said they had stopped doing it because ENT had wanted to take over the service completely. That GP retired soon after and nothing changed at the surgery.

[Happyrosie]

Thanks for this, Oldskir. My doctor's surgery will only remove wax if it covers the eardrum, and only then after waiting for some weeks and using olive oil.

So I have mine microsuctioned. Yes, it's noisy during the procedure and its expensive but it is well worth it for the relief. T is better afterwards because I can hear the real world better.

So I am afraid I disagree with your conclusions. An irrigation procedure could be dangerous - that's why the nurses at my doctor's surgery will not attempt irrigation unless the eardrum is completely covered.

And indeed ANY procedure could be dangerous, whether an Eply procedure for relief of dizziness or mastectomy for breast cancer. You have to weigh up the pros and cons.

[CDPO16 in reply to Happyrosie]

It is true to say that ear syringing is dangerous if not done carefully. If the syringe isn't angled properly and too much force used it is possible to perforate the ear drum. Microsuction replaced syringing as it doesn't carry that risk but isn't without it's own risks.

[oldskir in reply to CDPO16]

Sorry, but no one is using old style syringing any more. That of course carried a risk of too much pressure being applied.

The better procedure is water irrigation. This uses a device where water is warmed to a correct temperature in a plastic container within a special irrigation machine. The water is then channelled in to the ear canal at a fairly low pressure (which crucially is controlled at the right level by the machine) through a plastic tube. This gently and gradually flushes out the wax.

The use of the plastic tube means it is very easy to administer the water at the correct angle and avoid any danger of flushing direct on to the ear drum.

I have had water irrigation administered to both my ears over 20 times in the last 25/30 years, and not had a single problem with it. On the other hand, I had microsuction once, and it has caused damage.

I know which method I will be choosing next time I have a wax build up.

[CDPO16 in reply to oldskir]

Thank you for that information. I'm not familiar with the water irrigation method nor do I know of anyone using it in my area so don't have that choice.

[oldskir in reply to Happyrosie]

Hello Rosie, and thank you for your reply.

I am glad that microsuction worked well for you.

I am not calling for microsuction to be banned, just for it to be brought under some kind of sensible control/ better regulation.

I fully agree with you that you have to weigh up the pros and cons, and it is a personal choice.

But we should have a choice. I believe the removal of water irrigation at a number of GP surgeries is a retrograde step, and is being done more as a money or time saving measure rather than making genuine clinical sense. Also, a number of practices have simply failed to train up other staff in the use of water irrigation equipment, so when the nurse who usually did it has left, they then have a problem.

Recently, a friend of mine was told by his surgery they were not doing any ear wax removal, and he should buy a self administered irrigation kit from Boots. That sort of thing is, I think, truly dangerous.

A neighbour of mine works in the local ENT unit, and she says that a number of GP practices have been using Covid as a reason/excuse not to do wax removal. They are then dumping them on to the ENT department, and they are overloaded there with the demand for wax removal.

It is important to remember the NICE guidelines on ear wax removal. They have stated clearly that it should be available and be carried out in primary care, ie the GP surgery.

And they also say water irrigation is a perfectly good method.

[doglover1973]

Nice work oldskir I'm sorry to hear of your experience. People with T need to have all the info so they can make informed decisions and all the options so they don't have to compromise the health of their ears. I really hope you get a reply and - if you do - please let us know .

[oldskir in reply to doglover1973]

Thank you for your kind reply.

I have had tinnitus for around 54 years, and have managed to contain it at roughly the same level...until the microsuction in July.

Mine is mainly in the left ear, some in the right. All caused I think by a mixture of attending loud rock concerts/discos, an ear infection and discharge, and regularly being prescribed the antibiotic oxytetraline during childhood and teenage years.

I try to keep as positive as I can, but I do feel a despair at times that the medical profession still has not come up with some kind of cure or proper treatment. When you think what they have achieved in terms of heart transplants, prosthetic limbs, gadgetry that allowed such as Stephen Hawking to "speak", the wonderful Covid vaccines etc, etc, we just haven't seen anything really for tinnitus.

And just on this issue of wax removal. It amazes me, really, that someone cannot come up with some safe ear drops that will actually dissolve away the wax, rather than just softening it and then having to have irrigation or suction.

I'm glad I discovered this forum a few months ago. We are a good community here and do our best to help each other with advice and information.

[doglover1973 in reply to oldskir]

I feel for you. I really do. It's so unfortunate. I don't think medics take T - and it's effects - as seriously as they ought to. That's why I suppose there's no treatment or cure as yet. As you say - there should be - given all other medical advances. This forum is a Godsend isn't it .. It's lifted my spirits so much over the last year . I hope & pray that your T will settle at some stage . Best wishes.

[TinnitusUKPat Partner in reply to oldskir]

I take your point oldskir - one immediate difference between the medical advances that you've illustrated and the lack of progress in remedies for tinnitus is a financial one. Tinnitus research funding is limited as the precise impact of the condition isn't clear enough to motivate national medical organisations, pharmaceutical companies and parties of interest to invest in solutions for it.

Some people suffer tremendously, others don't, some people with tinnitus have demonstrable hearing loss, whilst others don't - that level of uncertainty makes it difficult for companies to commit to upwards of $2 billion dollars to develop and trial medications or devices which might only return a percentage of that initial outlay or take years to recoup it.

I don't agree with it, but that is somewhat where we are in terms of those bigger questions.

[oldskir in reply to TinnitusUKPat]

Hello Pat, Many thanks for your reply.I can take on board some of what you say re financial costs, but I'm afraid that I still disagree with you to quite a significant extent.

There are an estimated 6 million tinnitus sufferers just in the UK, and around 50 million in the USA. Heaven knows what the total worldwide figure is. Surely there is huge financial potential for any pharmaceutical company to make a lot of money from this vast number of T sufferers if they were able to find some medication to even just alleviate T, let alone cure it.

And in my view, they have spent money previously on things which don't look like money spinners. The equipment used by Stephen Hawking must surely have been incredibly expensive, with very little profit to be made there out of a miniscule number of sufferers who would need to use it.

In recent years we seem to have seen drugs developed to treat a number of very uncommon and obscure cancers, again the companies are unlikely to see much profit there, as so few people need those drugs.

So I remain of the view that the pharmaceutical companies should be doing far more to develop some better help for tinnitus, and indeed better drops to actually dissolve away excess ear wax.

[TinnitusUKPat Partner in reply to oldskir]

Whilst the figures that you are referring to are accurate, there is a lot of ambiguity about how many of those 6-8 million people in the UK are 'suffering' with tinnitus, because that's the figure which is important to the pharmaceutical companies and national health agencies with vested interests in identifying cases of people needing treatment.

The same figures you've used go on to suggest that the numbers of people who identify as experiencing significant, problematic tinnitus which has an impact on their lives in the hundreds of thousands, not millions. How accurate those numbers are is another matter, as if there's one thing we do realise about health issues, its that that can be underreported and that a true picture is notoriously hard to realise.

This illustrates an essential problem with tinnitus - many people do not suffer with it. They live a life which is only occasionally interrupted by it. At that point, the end market for a product, costing billions of pounds to develop, becomes smaller and the idea of returning a profit on the initial outlay becomes more uncertain.

Should pharmaceutical companies be doing more to alleviate illness, disease and suffering? Absolutely, they should. In my view - not the BTA's, I hasten to add - the idea of for profit medicine and treatment is morally very murky and a consideration that we shouldn't have to make.

[oldskir in reply to TinnitusUKPat]

Hello Pat, Thank you very much for your latest reply. What you write paints quite a pessimistic picture.Can you tell me, are any of the pharmaceutical companies doing any work at all right now to try to develop some kind of new tinnitus treatment /alleviation?

Are any of them doing any work to develop some better ear drops that would dissolve and melt away excess ear wax, so no one would need to resort to microsuction or water irrigation?

[TinnitusUKPat Partner in reply to oldskir]

Yes, Oldskir, there are usually multiple clinical trials being explored worldwide at any one time which will have some bearing on improving tinnitus for those affected by it. Few of those trials which have sought to produce a universal pill or medication for a problem as complex as tinnitus have been able to achieve more than limited success in suppressing it.

We have a section on tinnitus.org.uk dedicated to research news. Within that, we provide links to access and apply for clinical trials, for people who want to explore that option:

tinnitus.org.uk/links-to-vo...

nihr.ac.uk/patients-carers-...

bit.ly/3Ev8ero - the link for currently recruiting tinnitus clinical trials on Be Part of Research, the NIHR portal

It's worth saying that searching for clinical trials targeting conditions like hearing loss or thyroid disorders, will be likely to yield more search results from such sites - most research sites of this type are unlikely to tag tinnitus as being a primary goal of their work.

[Blonde600 in reply to oldskir]

Hi oldskir. I agree with you totally, I am exactly like you on this, loud in left ear 24 7 and slight in right ear, also love my music. Also yrs of been there and done that. I also agree and fed up of repeating myself on here on, this day and age with everything, not even something to take just to relieve this condition. There are too many suffering, being told to put up with and people even talking of and some have in fact , taken their own lives.

[TurboTrace]

Jesus! My heart goes out to you 😔

[Blaurot]

Last year I developed severe Hyperacusis and it exacerbated my Tinnitus after a micro-suction earwax removal procedure. I thought I was in safe hands when an ENT doctor removed my earwax but sadly that was not the case. Some years earlier I developed hearing sensitivity for a few days as a result of a micro-suction earwax removal procedure. I made the ENT doctor aware of this. He pointed out he had plenty of experience and knew what he was doing. In spite of my previous problems the ENT doctor did not highlight any risks nor did he take extra care. A few days later I developed severe Hyperacusis. I feel very angry that no health checks were made and that I was not informed of any possible side effects and risks prior to the treatment. I still have Hyperacusis which affects my everyday life and have to use noise-reducing headphones when outside (mainly for traffic noises). I think it is high time that the public were made aware of the possible risks of micro-suction earwax removal. I applaud you for taking on the government over this issue. Wishing you all the very best.

[oldskir in reply to Blaurot]

I'm so sorry to hear of your bad experience also. You have my every sympathy.Unfortunately, we are not alone. A simple Google search of "Microsuction has caused tinnitus/damaged my hearing" will bring up plenty more examples.

The whole concept of microsuction seems intrinsically unsafe to me. When we already know that loud noises can cause hearing damage and tinnitus, the idea of introducing sounds akin to a dental drill or noisy vacuum cleaner right down in to the ear canal seems clearly dangerous to me.

I am surprised that no one has found a way to make microsuction less noisy. I have seen one or two suggestions that a finer nozzle/cannula could reduce noise levels, and running the machine more slowly, but I can't really find any provider offering this in practice.

Even more surprising is that the pharmaceutical industry (which has had many amazing successes in other spheres) cannot come up with some ear drops that can actually dissolve excess ear wax, rather than just soften it.

I honestly believe that some audiologists like microsuction because it is quicker and more convenient for THEM. They often use loaded terms like "messy" to try to denigrate the quieter and gentler procedure of water irrigation.

I believe people should have a choice, and I would like to see as many GP practices as possible re-instate water irrigation.

[Suzysunday]

I got tinnitus from micro suction at specsavers 18 months ago and it continues. Never had it before. I did sign a form but the risks were not fully explained. I wish I had never had it done. I really don't think specsavers should be allowed to do this procedure. I complained to them but they didn't care.

[oldskir in reply to Suzysunday]

Dear Suzy, I'm so sorry to hear that you have had a bad experience also.Is it one ear or both that have been affected? Have you had any improvement at all after 18 months?

This is why I think greater regulation of those offering wax removal services is urgently needed. People like Specsavers are being allowed to make money by inserting very noisy microsuction nozzles down in to people's ear canals and there doesn't seem to be any proper checks or regulations on how they can operate.

I suggest you do what I have done, and ask your local MP to pass your concerns on to the Department of Health. I have also suffered some hearing loss from the microsuction.

In my view, the Department of Health need to be asking all GP practices to re-instate a free wax removal service using the gentler method of water irrigation.

I also think the BTA should be championing this overall issue, but I won't be holding my breath.

I do hope you get some improvement as time goes on, perhaps you will update us on this forum if anything changes for you.

You have my Best Wishes for hopefully some happier days ahead.

[Suzysunday in reply to oldskir]

Thank you for your concern. It was just one ear that was treated and it's just the same now as when it started, though thankfully no worse. I thought that GP's had similar concerns regarding irrigation. I rushed into micro suction, which is not like me and you assume it'll be okay. I was surprised how many people do business messing with eat wax, all sorts of things that don't seem safe. I never considered the noise the suction would make, like a mini vacuum cleaner.

[Blaurot]

I also found the micro-suction procedure far too noisy. I pointed this out to the ENT doctor who removed my earwax but he made no attempt to remove the ear-wax more gently. Surprisingly, he replied that the noise was still within the safe noise threshold. Unfortunately no risk assessment was made although I had problems in the past with hearing sensitivity after a micro-suction earwax removal. I also had water irrigation in the past and noise was never an issue. Hopefully the water irrigation method will be re-instated.