Ear Syringing
Our bodies are confined by skin which is waterproof and an effective barrier to most harmful external agents. The ear canal is lined with skin, which unlike skin elsewhere, cannot be reached with a finger. When it is dirty it cannot be washed, when it is wet it cannot be dried, when it itches it cannot be scratched by finger nails and when it is sore it cannot be soothed. The lining of the skin of the ear canal grows upward from its deepest layer of cells. Older cells are pushed towards the surface eventually forming a layer of dead cells. Scales of these dead skin cells, similar to those rubbed or washed off elsewhere on the body, accumulate in the ear canal. At the same time glands within the skin of the ear produce a waxy secretion which mixes with the dead cells. It is this mixture that we call ear wax. It may be soft, even runny, if the secretion predominates; or firm and hard if it is mainly composed of dead cells. While the skin is growing from the deepest layers to the surface, it also grows sideways and migrates out of the ear canal. This has been illustrated by placing a drop of Indian ink on the ear drum. If inspected daily over a period of weeks, it appears to move along a spiral path and eventually drops out of the ear. This process, unimpeded, normally keeps the ear clean by carrying away any dirt or wax on the surface of the skin as it migrates. If this self-cleaning system fails for any reason, or if the wax is pushed back into the canal by over-enthusiastic cleaning, the wax collects and may block the canal. This commonly occurs without any problems and, therefore, needs no action. However, occasionally wax does produce problems. The commonest is a slight degree of deafness. In people with troublesome tinnitus, this deafness may be sufficient to increase the apparent loudness of the tinnitus, which is often masked during the day by background sounds. In some individuals the presence of wax covers the masking effect of the background noise. The tinnitus is brought to the subject’s attention by the wax. Some will lose the sensation after syringing, but a few will continue to be aware of the sound and be concerned about it enough to make the symptom into a medical complaint. Someone with troublesome tinnitus, whose ears are blocked by wax may, therefore, benefit from having it removed. People who have eczema or dermatitis of the ear are likely to have a reaction to some of the additives, resulting in itching, pain or discharge from the ears. For this reason ear drops should only be used when there is a good reason for removing the wax and only if there is no known tendency to skin problems. Even if the drops are used, they do not always clear the wax. The common alternative is syringing. Water, at body temperature, is injected through the nozzle of a syringe into the ear canal. Under the gentle force of the syringe, it runs into the deepest part of the canal where it forms eddies which dislodge the wax. The wax is carried out of the canal by the continuous flow of water for as long as the syringing continues. If the wax seems hard, it is best to soften it by the use of drops for one or two days prior to the syringing. In competent hands and with a relaxed subject, the procedure is usually painless and effective. Considering the vast numbers who have their ears syringed each year (perhaps a million in the UK) the numbers of serious complications are small. However, there seems to be a very small number of cases where the procedure coincides with the onset or aggravation of tinnitus. The reason for this is not clear. Pain in the outer ear canal should not “cause” tinnitus which is quite a different sensation. The noise of syringing has been measured and it does not seem to be very loud, certainly not loud enough to cause noise induced damage. It has been suggested that there may be nervous reflexes, perhaps to the temperature of the water used, either too warm or too cold, but there is no proof, so this remains a theoretical possibility only. Perhaps the most likely explanation is that syringing, especially if unpleasant for any reason, can act as a trigger to bring the patient’s attention to nervous activities which are already present, but hidden within the auditory pathways of the nervous system. The emotional response to pain or anxiety which can accompany syringing may be sufficient to make the hearing mechanism more sensitive, enough to detect and amplify these faint auditory signals, which once heard, become established in the consciousness as tinnitus. If the tinnitus is seen as a result of damage caused by syringing, understandable but perhaps misplaced anger will ensue. This may prevent habituation (the process by which we cease to listen to boring background noise of no significance), and the tinnitus will become more intrusive and persistent. It could be a combination of some of the factors mentioned which links syringing with tinnitus, or there could be other mechanisms of which we are, at present, unaware. In some cases it may even be coincidence. There are syringing alternatives available to be administered by a Medical Practitioner. Wax can be removed with a metal probe or hook. In skilled hands, this is easy and effective, but likely to be more painful. It is used far less than syringing, and it too may sometimes be associated with the onset of tinnitus. Suction, through a narrow tube, is another method used in ENT departments to clean ears. This is much noisier. It sucks cold air into the ear and can be painful if the skin is sensitive or inflamed. Like the other method it too has been associated with tinnitus. To summarize:
This information is not a substitute for medical advice. You should always see your GP / medical professional. This article reproduced kindly with the permission of Tinnitus Association Victoria. |
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