Glue ear may be secondary to an acute otitis media (acute middle-ear infection) or a result of eustachian tube dysfunction. It has an incidence of 40% in children aged two years, reducing to 1.4% in those aged 11 years [5] We aim to provide you with the knowledge and support you need to make confident decisions about your

Adverse events (such as irritation, otitis externa and perforation of ear drum) were reported in the evidence for hydrogen peroxide before irrigation, but the committee noted that the majority of studies did not report adverse events, so no conclusions could be drawn about adverse events of other treatments. The committee noted that sodium bicarbonate can also cause irritation. In contrast, there is some evidence that favours hydrogen peroxide alone (without irrigation). The committee noted the risk of potential confounding, for example if patients have used a cotton bud at the same time as the softener. The committee confirmed that hydrogen peroxide is no longer used in most clinical settings; however, it is available in pharmacies and is commonly used by the public in self-management. There is no evidence that hydrogen peroxide is more effective than other softeners before irrigation and there is evidence of a risk of adverse events, however overall the committee did not feel that there was sufficient evidence to justify making a negative recommendation about hydrogen peroxide. Some ear wax remover liquids come in spray form, which you may find easier to administer than drops. Some also come with special syringe-style applicators to help get the solution safely into your ear and deliver a measured amount with each squirt.

All substitutes

A common ear problem that patients of all ages may present with is hearing loss or deafness. Young children commonly present with fluctuating hearing loss, known as ‘glue ear’, which is caused when the middle ear — normally air-filled — becomes filled with fluid. This fluid tends to look like glue, hence the name. Patients presenting with sudden hearing loss in one ear as a sole symptom should be referred urgently to a GP. The cause may be sensorineural (i.e. caused by a lesion or disease of the inner ear or the auditory nerve) and oral steroids with or without antiviral medication may be beneficial [11], [12] Adults may also experience glue ear. This usually occurs after a cold and, although rare, it can be the presentation of a mass in the post-nasal space. As glue ear is less common in adult patients, they should be referred to their GP who can then refer them to the ENT specialist.

You have had your ear syinged in the last 2 to 3 days, or tried to remove ear wax with your fingernails, cotton buds or other implements, as this could make it painful to use the ear drops

Pharmacy product

Although it is not always clear what causes tinnitus, it is often associated with damage to the inner ear [15] Microsuction can be used in many cases where ear irrigation is contraindicated such as tympanic membrane perforation, some foreign bodies, mild otitis externa and in some cases of previous ear surgery. The training and experience of the person performing the procedure will dictate the cases they are competent to manage.

eardrops – dropsused several times a day for a few days to soften the earwax so that it falls out by itself A dry ear is unlikely to become infected, so be sure to dry your ears thoroughly after swimming or bathing. This liquid treatment comes with a handy rubber squeeze bottle (basically a syringe) which makes the drops easy to administer without causing a mess. You can use the bottle to keep your ears clean with warm water once the treatment has cleared out your excess ear wax. Users report that it only takes around three or four days of twice-daily treatment to clear their ears.Ear drops are liquid medications that you put inside your ear canal. You can buy some kinds of ear drops over the counter. Others require a prescription from a healthcare provider. It is important to be aware that some antibiotics — including the aminoglycosides (gentamicin and neomycin), ciprofloxacin, clarithromycin — and chemotherapy agents — such as methotrexate and cisplatin — are known to cause or worsen tinnitus. Medicines used to treat hypertension (such as angiotensin-converting-enzyme inhibitors), hypercholesterolaemia (such as atorvastatin), anxiolytics and antidepressants should also be reviewed as they can potentially cause tinnitus. Irrigation of the ear canal should be undertaken using warm water and an electronic ear irrigation machine with a variable pressure control. A jet tip is used to angle the flow of water along the top of the posterior wall. Historically ear syringing was used and this is evident in the papers reviewed. The effect is the same but irrigation is a much safer method and syringing is now contraindicated because of adverse effects, namely trauma. Ramsay-Hunt Syndrome (i.e. herpes zoster oticus) may be considered in patients presenting with all or some of the following symptoms:

Sanchez TG, Mak MP, Pedanlini MEB et al. Tinnitus and hearing evolution in normal hearing patients. Int Arch Otorhinolaryngol 2005;9(3):220-227One UK health economic evaluation was identified, which was carried out as part of an NIHR health technology assessment. This compared 3 options: no treatment; treatment using softeners for a week and self-irrigating (using a bulb irrigator) if the wax does not clear; using softeners for a week and returning to a GP if the wax does not clear. The study described its results as “exploratory and should not be used as a basis for changing policy and practice”. You should consult a healthcare provider before using ear drops. Additionally, you should avoid using ear drops at all if you think you could have a ruptured eardrum. Symptoms of a ruptured eardrum include ear pain, hearing loss, ringing in your ears, ear drainage and vertigo. Why would someone need to use ear drops? The committee noted that self-irrigation is not commonly recommended in the UK. There are concerns regarding the safety of self-irrigation, and recommending this approach would conflict with the separate recommendation to advise people not to insert objects into their ears. The committee noted that the ‘exploratory’ study showed that GP-administered irrigation was not cost effective compared with self-irrigation due to very little additional benefit to quality of life from increased effectiveness. However, the committee noted that only 1 clinical study was identified reporting adverse events for self-irrigation. The committee agreed that self-irrigation is a potential method that it needed to consider, but decided that at this stage there is too little evidence regarding its safety for the committee to be confident that such a significant change from current practice would be safe. The committee considered making a recommendation for further research. Although such research would be welcomed, the committee decided that the other questions identified in this guideline are currently higher priorities. Sodium bicarbonate is the chemical found in baking soda. It’s a form of salt that causes dirt and grease to dissolve in water, as well as being brilliant at absorbing odours, so it has all manner of household uses. It also does a great job of softening ear wax, and is recommended by clinicians as a gentle natural alternative if your ear wax problem isn’t too serious. A build-up of earwax is a common problem that can often be treated using eardrops bought from a pharmacy.