Yes. You read that correctly. In the UK, ear wax removal is unregulated which means that we are experiencing a surge in people providing it (and this is indeed the case in Cardiff too) who have absolutely no clue about about the anatomy and physiology of an ear or in depth understanding of any potential pathologies that may be picked up whilst doing the procedure. Isn’t that scary.

Very recently, we had a lady come to our practice who, on the surface of it, appeared to have stubborn ear wax and needed multiple visits to attempt removal. Emma, our Hear Care Assistant, noted that there wasn’t something quite right about the consistency of the underlying debris in the ear canal and flagged this up to our Lead Audiologist, and owner, Sonja.

Sonja examined the ear and suspected that the patient may have a rare condition called a ‘cholesteatoma’. More often than not, this is something we might see behind the ear drum under our microscopic, but the type Sonja suspected was growing in the bone of her ear canal.

A cholesteatoma is a type of non-cancerous growth or cyst that can occur in the middle ear or mastoid bone behind the ear. It is typically caused by the accumulation of dead skin cells and other debris in the ear, which can lead to the formation of a sac-like growth. Over time, this growth can enlarge and cause damage to the bones of the middle ear, leading to hearing loss, vertigo, and other complications.

While cholesteatomas typically occur in the middle ear or mastoid bone, it is possible for them to develop in the ear canal bone as well. This type of cholesteatoma, called an external auditory canal cholesteatoma, is less common than those that occur in the middle ear, but can still cause hearing loss, pain, and other symptoms.

External auditory canal cholesteatomas typically occur when skin cells become trapped in the ear canal and begin to accumulate, leading to the formation of a cyst or growth. They are more common in people with a history of ear infections or trauma to the ear, and may require surgical removal to prevent further complications.

In general, any type of cholesteatoma should be evaluated and treated by a medical professional, such as an ENT (ear, nose, and throat) Consultant, to prevent further damage to the ear and preserve hearing.

Emma was absolutely right to flag this situation up as if she did indeed have a cholesteatoma, this requires urgent medical attention, assessment with a CT scan, and likely surgery.

This week, our patient wrote to us and advised the following:

“I just wanted to give you an update as promised . I have had it confirmed by ENT that I do indeed have a cholesteatoma; I’m going to be having surgery soon. I just want to say thank you so much; if I hadn’t come to you to have them [ears] cleared out I most probably would have never known untill significant damage had been done . Just want to thank you all so much for getting me sorted.”

The worrying thing here is that the patient had no symptoms to suggest something might be wrong and as she had ears blocked with wax anyway, it would be very easy on first inspection to simply say “your ears are just blocked with wax and this needs removing”.

We know times are hard but please don’t be lured in by low priced ear wax removal being advertised by beauticians, podiatrists, chiropractors, a nurse with little experience of working with ears, or average Jo(sephine) Bloggs.

Your sense of hearing is too valuable to see someone other than a hearing care specialist.

Ear wax removal may seem like a simple task, but it can actually be quite complex and potentially dangerous if not done properly. It is important to see a professional who has specialised training and expertise in ear wax removal, such as an Audiologist, Hear Care Assistant or a nurse with extensive training and experience in the field.

Beauticians are not trained to diagnose or treat medical conditions, including ear wax buildup or impaction. In our view, they should never be accepted into a course.

Similarly, while podiatrists are experts in foot care, they are not specialists in ears. Perhaps a nurse has decided to do some wax removal to supplement their NHS income…just because they’re a nurse, it does not mean they have had extensive training, clinical mentoring, or experience with ears.

You wouldn’t want an audiologist poking about in your eyes, looking after your feet, or giving you a facial would you? Then why would you see someone who is not a specialist in ears for ear wax removal?

Sadly there are day courses popping up training such professionals in ear wax removal. A day or twos training is categorically not enough.

An audiologist (or hearing health professional) on the other hand, has extensive knowledge of the anatomy and physiology of the ear and is trained in safe and effective ear wax removal techniques. They use specialised tools, such as suction devices or curettes, to remove ear wax without causing damage or discomfort to the ear. Additionally, audiologists can identify any underlying hearing or ear-related issues that may be contributing to the ear wax build up or diagnose any relevant medical issues…such as a cholesteatoma!