Ear irrigation for ear wax

For years, having your ears flushed out by the practice nurse was the standard fix for a blocked ear. The method has moved on since then. Modern ear irrigation uses an electronic pump rather than a hand-held metal syringe, and the pressure is set by the machine instead of by someone's thumb. It remains a common way to clear ear wax in GP surgeries and private clinics.

What is ear irrigation?

Ear irrigation washes ear wax out with water. An electronic irrigator pumps water, warmed to around body temperature, through a nozzle fitted with a single-use tip. The clinician chooses the pressure, starts low and can stop the flow instantly.

The water isn't aimed straight at your eardrum. It is directed along the upper back wall of the ear canal, so it flows past the wax, builds up behind it and pushes it out. Water and wax drain into a small basin held under your ear.

You will still hear this called ‘syringing’, sometimes by GP surgeries, although the old hand-pushed metal syringe is no longer used and NICE says it should not be offered. Our page on ear syringing explains the difference.

How ear irrigation is done, step by step

1. Questions and a look in your ears. The clinician asks about perforations, grommets, ear surgery, infections and discharge, then checks with an otoscope that the blockage is wax and the canal looks healthy.
2. Getting set up. You sit upright with a waterproof cape or towel over your shoulder. A basin is held against your neck, under the ear, sometimes by you.
3. Straightening the canal. The clinician gently pulls your outer ear up and back and places the tip just inside the entrance of the canal. It doesn't go deep.
4. Short bursts of water. Warm water flows in for a few seconds at a time. Between bursts, the clinician looks in to see how much wax has come away.
5. Draining and a final check. Once the canal is clear, they tilt your head to let the water out, dry the entrance of the ear and check your eardrum.

Stubborn wax doesn't mean trying harder. NICE advises softening drops again, or putting a little water into the canal 15 minutes before a second attempt. If that fails too, the next step is a referral to a specialist ear care or ear, nose and throat (ENT) service, not a third go.

Preparing: softening the wax first

Irrigation works far better on soft wax, so preparation matters more than it does for microsuction. NICE advises using a wax softener either immediately before irrigation or for up to 5 days beforehand, and you will usually be asked to do the second.

The NHS suggests:

Pharmacists also sell softening drops such as sodium bicarbonate or urea hydrogen peroxide. Your ear may feel more blocked for a day or two as the wax swells. That is common, and it doesn't mean the drops aren't working. Our guide on how to use ear drops explains how to get them where they need to go.

What it feels like and how long it takes

Most people find irrigation strange rather than painful. You feel warm water filling the ear, hear a gurgling rush and may notice some pressure. A trickle sometimes escapes down your neck, basin or not. When a plug of wax comes free, your hearing often comes back all at once.

Water that isn't close to body temperature can make you dizzy for a short time, because temperature changes in the ear canal affect the balance organ nearby, so the clinician checks it before starting. Tell them straight away if you feel dizzy, sick or in pain.

The irrigation itself usually takes a few minutes per ear. With the questions and checks, the whole appointment is often around half an hour.

Who shouldn't have ear irrigation?

Because water goes into the ear under pressure, irrigation is avoided when it could get through the eardrum, carry infection deeper or disturb an ear that is healing. A clinician will usually choose another method if you:

In these situations microsuction or manual removal by a trained clinician is usually the safer choice, because nothing wet goes in. Mention your ear history when you book, even if it was years ago.

Risks and side effects of ear irrigation

Electronic irrigation is far more controlled than the old metal syringe, and problems are uncommon when it is done by someone trained to use it. The side effects people notice most are short-lived:

Less often, water left in the canal or a small graze leads to an outer ear infection (otitis externa) a few days later, with itching, pain and sometimes discharge. Damage to the eardrum is rare with electronic irrigation, but it can happen, which is why the questions about your ear history matter so much. And sometimes irrigation simply doesn't shift the wax, so you need a second attempt or a different method.

Ear irrigation or microsuction?

NICE treats the two as alternatives. Irrigation is quieter, and where wax removal is still offered on the NHS it is often what the practice nurse uses. Microsuction keeps the ear dry, often needs no drops and lets the clinician watch the wax throughout. For many people either would work.

Our full comparison of microsuction and ear irrigation goes into more detail if you are weighing them up.

Aftercare

Tilt your head to let any leftover water drain out, and dry the outer ear gently with a towel. Over the next few days:

• keep cotton buds and fingers out of the ear canal
• keep the ear dry for a day or two if the clinician suggests it, for example by skipping a swim
• look out for signs of infection, such as itching, pain, swelling or discharge, and see a pharmacist or GP if they appear

If your hearing is no better, or the ear still feels blocked, go back to the clinician rather than trying again at home. Our aftercare guide covers the first few days in more detail.

Cost and NHS availability

NICE guidance says adults should be offered ear wax removal in primary care or community ear care services when wax is causing hearing loss or other symptoms. Where GP surgeries still remove wax, irrigation by a practice nurse has long been the usual method, but many have stopped, so ask at yours or at a pharmacy. Our guide to ear wax removal on the NHS explains the options.

Private prices vary with the clinic and the area. As a rough guide, a clinic appointment for both ears typically costs between £45 and £100, whichever method is used, and home visits cost more. See how much ear wax removal costs for what is usually included.