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Eustachian Tube Dysfunction (ETD) And How To Treat It

Annotated diagram of the ear
Annotated diagram of the ear
By Chittka L, Brockmann [CC BY 2.5 (], via Wikimedia Commons

Eustachian Tube Dysfunction (ETD) And How To Treat It

ETD explained…

The Eustachian tube connects each middle ear (an air-filled cavity behind your ear drum) with the back of the throat.  The normal position of the Eustachian tubes is closed, however they open when we swallow or yawn.  If you want to know how they do that, they are attached to the tensor veli palatini muscles in your soft palate which are activated automatically whenever you yawn or swallow.
If the Eustachian tube is blocked or does not open properly, air cannot get into or escape from the middle ear resulting in unequal pressure either side of the eardrum.  This can cause pain, discomfort, a popping and/or blocked sensation, hearing loss, tinnitus or dizziness.  ETD can be caused by a middle ear infection, resulting in the build up of fluid behind the eardrum causing the eardrum to become retracted.  Other common causes include: a cold, allergies, sinus infections, altitude changes, or infected adenoids (two small pads of tissue, close to the Eustachian tubes, that are believed to play a role in immune system activity).

How To Treat Eustachian Tube Dysfunction

ETD generally resolves by itself without treatment.  However, there are a number of ways to provide relief and these are described below.  If symptoms are severe or persistent for more than two weeks then it is recommended to seek the advice of your GP.
There are a number of methods that help equalise this pressure in the ears which can be carried out at home.  Each or a combination of these techniques may need to be done mulitple times in order to provide relief.
NOTE: We advise against practising ear equalisation techniques if you have a current or recent middle ear infection, unless on the advice of your GP or other medical doctor.

Equalisation techniques for Eustachian Tube Dysfunction

Valsalva manoeuvre: take a breath inwards, close your mouth, pinch your nose and gently blow outwards through your nose until you feel your ears pop.  
Toynbee manoeuvre:  take a sip of water, pinch your nose and swallow the water with your nose pinched.
Lowry manoeuvre: this technique is a combination of the Valsalva and Toynbee methods.  It involves pinching the nose, closing the mouth, gently breathing outwards and swallowing at the same time.  
Jaw wriggling technique: open your mouth and wriggle your jaw from side to side until your ears pop.
Another alternative is to use the Otovent, which increases pressure in the nose and opens the eustauchian tube.  This allows pressure equalisation and if fluid is present behind the eardrum, it allows this to be cleared.  An otovent kit can be bought from a pharmacy or can be obtained by special order without perscription.  The kit generally consists of: a plastic device and balloons.  It does not matter which nostril is used or if you only feel blocked in one side, this technique can be safely followed.  

Otovent Basic Method

  • On first use, stretch the balloon.
  • Place the balloon over the flat end of the plastic device.
  • Hold the round part of the device against one nostril
  • Press the other nostril closed with the other hand.  
  • Inhale, close your mouth and inflate the balloon by blowing through the nostril. 
  • Repeat on the other side.

Otovent Advanced Method (additionally requires a glass of water)

  • Place the balloon over the flat end of the plastic device.
  • Half inflate the balloon with your mouth (through the plastic device) and hold the air in by squeezing the mouth of the balloon with your thumb and finger
  • Using your other hand, take a sip of water and hold the water in your mouth
  • Breath in through your nose
  • Place the Otovent against one nostril
  • Press the other nostril closed with the other hand
  • Allow the air from the balloon to start flowing
  • As the air starts to flow, swallow the water
  • You should hear a funny sound – this is quite normal
Congestion relief can also be provided by over-the-counter decongestants such as Sterimar Congestion Relief.  This can be used 3-5 times daily.  Relief should be felt within 2-3 days, after which the frequency of use can be reduced until relief is maintained.  If symptoms persist, seek the advice of your GP.

Surgical Treatment For Eustachian Tube Dysfunction

Myringotomy (“Grommets”)

In the case of frequent middle ear infections, a referral may be made to an Ear, Nose and Throat (ENT) surgeon. The surgeon may recommend an operation to make a tiny incision in the eat drum (known as a myringotomy) and insert a ventilation tube (tympanostomy tube or “grommet”) into the ear drum. This will allow fluid to drain from the middle ear, and for the air pressure to equalise on either side of the ear drum. Ear ventilation tubes usually fall out on their own after six to nine months. After this surgery, it is important to keep the ears dry, as otherwise if any water gets into the ear canal it can cause a middle ear infection. At the time of writing (July 2018), myringotomy surgery under the NHS is slated to be restricted to only the most severe cases, with the Otovent being recommended as an alternative.

Balloon Dilatation of the Eustachian tube

This is a relatively new operation (only available since 2011 in America, and FDA approval was only granted late in 2016). During the procedure, a balloon is passed through the nose and inserted into the Eustachian tube and then water is used to inflate the balloon to 10 bar for 2 minutes. This stretches the Eustachian tube and can potentially cure Eustachian tube dysfunction. Often, a grommet operation will be performed before this surgery as a test to increase the likelihood of success with balloon dilation. The criteria for this operation and the pre-operation tests are far more stringent than for myringotomy, but one advantage is that patients don’t need to avoid getting their ears wet afterwards.
You can find out more about this operation here.
See the following links for further information and practical demonstrations of the ear equalisation techniques described.  

Frequently Asked Questions (FAQ)

Microsuction Frequently Asked Questions FAQ

Frequently Asked Questions (FAQ)

Many people are familiar with irrigation (also known as ear syringing), but have never experienced microsuction (also known as ear wax suction) and naturally want to know more about this procedure. Here are some frequently asked questions about microsuction:

Where Can I Get Ear Wax Removal Near Me?

At the Microsuction Earwax Removal Network, we currently have 8 clinics around London and Hertfordshire, with plans to open more clinics in London, Surrey, Essex, Kent and Berkshire later this year.

Our ear wax removal clinic locations are:

Central London

North London

West London

Northwest London


Do I Need A Medical Referral For Microsuction?

If you take the NHS route, you will need a medical referral from your GP to have microsuction performed in a hospital Ear, Nose and Throat (ENT) clinic. As this costs the practice a lot of money, they may be reluctant to refer you on your first visit, and many GP practices have a protocol whereby they will recommend olive oil drops for 2 weeks, and if that doesn’t work change it to sodium bicarbonate drops for a further two weeks, and if that doesn’t work, change it to hydrogen peroxide or urea peroxide to two weeks before referring to the next stage. Depending on where you are, waiting times for microsuction on the NHS may range from 6 weeks to 6 months. Apart from these stronger ear drops possibly making the ear sore, many people can’t wait 12 weeks or more to be able to hear again.

The alternative is to self-refer yourself to one of our clinics. You can book an appointment online here, or call us on 0800 1 337 987. We can often see you on the same day.

What Is The Difference Between Microsuction And Syringing?

Syringing uses a syringe to squirt water into the ear, while irrigation uses an electric irrigation pump. A small handheld magnifier with a built in light called an otoscope is used to locate the ear wax blockage. The idea is that by squirting water past the wax blockage the water pressure will build up behind the wax and push it out. As the ear is full of water during the flushing process, it is not possible for the nurse to accurately see what is happening throughout the whole procedure. It is usually necessary to loosen the wax by applying olive oil for around two weeks prior to an irrigation procedure to make sure that the wax comes out easily. In a way, the method is slightly counter-intuitive as you want to get the wax out, but they push high pressure water in in the hope of getting the wax out. No wonder some people call the irrigation method “spray and pray”. The danger is that wax can get pushed further into the ear canal.

Also, if there is a complete blockage, it is not possible to examine the ear drum for a potential perforation or middle ear infection before performing an irrigation procedure. Irrigation should never be performed when the ear drum has been previously perforated, when the ear drum is currently perforated, or if there is a current or recent middle ear infection. Doing so could re-perforate a previously perforated ear drum, or perforated an ear drum that is weakened from a middle ear infection. Then water and ear wax can get flushed past the perforated ear drum into the middle ear, causing pain, dizziness and ear infection.

When an irrigation procedure goes well, it can provide instant relief, however when it goes wrong, some of the potential side effects are:

  • Pain
  • Dizziness
  • Bruising or bleeding of the ear canal
  • Outer Ear Infection
  • Ear drum perforation
  • Middle Ear Infection
  • Tinnitus
  • Hearing Loss
  • Facial Nerve Damage

When weighing up the benefits versus the risks, many GP surgeries have stopped performing ear irrigation procedures altogether.

Microsuction, on the other hand, uses very gentle medical suction accurately applied to the ear wax. Our microsuction practitioners are highly trained and use portable ENT (Ear, Nose and Throat) loupes, so that they can see exactly what is happening throughout your procedure and remove the ear wax with pinpoint accuracy. Because microsuction gently draws wax from the ear using low pressure medical suction, it cannot push wax further in, and the success rate is therefore far greater that that of irrigation. Microsuction is also considerably safer than irrigation. It is no wonder that microsuction is considered to be the gold standard when it comes to ear wax removal.

Does Microsuction Hurt?

In nearly all cases, ear wax microsuction does not hurt at all, as the medical suction unit is designed to use a very gentle level of suction. It can be a little noisy, but not a lot more than the noise of a hand dryer or vacuum cleaner. While some websites say that softening with ear drops is not necessary, we believe that using Earol sterile olive oil spray for at least two to three days prior to your procedure will make it more comfortable and maximise the chances of 100% ear wax removal, especially for people who have a history of very hard or impacted ear wax. People who have had a confirmed diagnoses of ear drum perforation should avoid using Earol or other ear drops.

A recent outer ear infection (otitis externa), or sometimes the use of ear drops containing hydrogen peroxide, urea peroxide or sodium bicarbonate can make the skin of the ear canal more sensitive, and as a consequence a microsuction procedure may be a little uncomfortable in these limited cases.

Most clients, however, find that an ear wax suction procedure is completely painless, and are delighted to be able to hear properly again.

How Successful Is Microsuction?

Despite being very gentle, microsuction is a more efficient method of ear wax removal compared to irrigation (ear syringing). Our success rate is one of the highest in the industry, and we will remove 100% of the ear wax in nearly all cases. In around 1 in 500 procedures, we may be able to remove only 90-95% of the blockage, which is still enough to either fully or mostly restore your hearing. There may be a small amount (5% to 10%) of the original blockage remaining as the last part is tucked around a corner, or stuck fast at the end, and cannot be safely removed. In this case we will put your safety first and recommend that you use Earol for another two or three days to loosen the last piece, and it usually comes out on its own. In rarer cases, something like 1 in 2000 procedures, a more significant amount may remain – perhaps 20 to 25% of the original blockage. This is usually because the wax was so impacted that the Earol was unable to penetrate all the way through the blockage, or it was used for an insufficient length of time. If this is the case, it will be necessary to re-apply Earol spray for several days and book another appointment.

The likelihood is that we will be able to remove all of your ear wax.

How Much Does Microsuction Cost?

We try to keep our prices competitive, and they are amongst the lowest in the industry. For example, many of our competitors charge the same whether you need wax removed from one or two ears; in contrast we give a discount if you need wax removed from only one ear. We also don’t charge a booking fee if you use our self-service online booking system.

In trying to keep our prices low, we have to take into account the varying amounts of rental we pay in different locations, and any overtime we pay our professional staff for unsociable hours.

In general, prices range from £80 for one ear during normal hours, to £125 for both ears outside of normal hours. You can see all of our prices when you book online.

Is Microsuction Completely Safe?

Microsuction is considered to be the safest method of ear wax removal. Most procedures pass completely without incident, which is partly down to the inherent efficiency and safety of the method, and partly down to the skill of our practitioners.

Like any medical procedure, despite our best efforts and high level of training, sometimes things happen that we would rather not happen. These tend to be minor in nature, and few and far between. For instance:

  • Less than 1 in 300 people find that the air going around their ear can make them temporarily dizzy for a few seconds during the procedure. If this happens, just tell your practitioner, who will take the suction tip out of your ear and in a few seconds you will feel OK.
  • If the wax is hard or has any crusty bits, as we suction it out it may drag along the skin of the ear canal and leave a little scratch. Like getting a scratch on the back of your hand, after a few days it will disappear as the skin heals itself.
  • Incomplete removal: Normally, we can remove all the wax. However, in around 1 in 500 procedures we may only be able to remove 90 or 95% of the original blockage, because the last part is tucked around a corner and it can’t be safely reached, or it is stuck solidly at the end and won’t release. In these cases we always put your safety first, and recommend that you use Earol for a few more days, so that the last bit will loosen and come out by itself. In rarer instances, around 1 in 2000 procedures, a more significant amount may remain, requiring 7 days’ application of Earol and booking a second appointment.
  • Coughing, sneezing or large movements: Please let us know if you need to cough or sneeze so that your practitioner can remove the suction tip from your ear for your safety, and then resume the procedure after you have coughed or sneezed.

Rarer complications

  • Exacerbation of existing tinnitus: This has been reported elsewhere, but we do not believe that it has happened to any of our clients. When this does happen, it is typically temporary. During the consent process, we ask if our client has tinnitus, and if it is worse in loud noise. Clients who are very noise sensitive can ask for dry instrument removal.
  • Hearing loss: People who find that loud noise, such as a vacuum cleaner or a hand dryer, causes them physical pain may have a genetic mutation which makes them susceptible to hearing damage at a far lower noise level than normal. In these very rare cases, dry instrument removal may be preferable to microsuction. The majority of people do not have this mutation and can have microsuction perfectly safely.
  • Minor bruising or grazing: Some discomfort of the ear canal post procedure can happen, especially for people with very narrow ear canals, or with a narrow point within the ear canal. This may be due to a large piece of wax coming down a narrow canal, limited space to manoeuvre the suction tube within the canal, or a combination of both. Bruising is more likely, but still rare, with the dry instrument removal procedure as some pressure is applied in the direction across the canal when hooking or scooping the ear wax. The aim is to hook or scoop the wax as gently as possible, and then draw the wax out along the canal, but despite our best efforts minor bruising or grazing can happen due to the hard or rough consistency of the ear wax.

Do You Offer Dry Instrument Removal?

All of our practitioners have had training in the use of instruments to remove ear wax. Sometimes they will use a combination of instruments and suction, and will choose the method or combination of methods that will result in the most comfortable and efficient removal procedure.

However, if you find loud noise, such as a vacuum cleaner or hand dryer, uncomfortable it may be preferable for you to have dry instrument removal instead of microsuction.

Will Microsuction Definitely Restore My Hearing?

While we can nearly always remove all of your ear wax, microsuction can only restore your hearing to whatever level it was at before you got an ear wax blockage. If you still struggle with your hearing after all the wax is removed, it may be caused by:

  • An underlying hearing loss: Hearing loss tends to creep up on people, and is so gradual that they don’t notice any change from one day to the next. It feels like one moment they were hearing people fine, and then the next, they could still hear people, but the words sounded muffled. Although ear wax can be a cause of hearing loss, it isn’t always the sole cause. If we remove your ear wax and you still struggle to hear, or if you have no ear wax, but feel that your ears are blocked and you can’t hear clearly, we will perform a hearing test for you, or book you in for a hearing test.
  • A recent cough or cold, hayfever or allergy: coughs, colds, hayfever and allergies can cause congestion in the back of the nose, and this in turn causes the Eustachian tube which leads from behind the ear drum to the back of the nose to block. The Eustachian tube would normally allow mucus to drain from behind the eardrum to the back of the nose, but this now has nowhere to go and soon builds up behind the ear drum, causing a loss of hearing. It will normally clear within a few weeks after a cold, but sometimes a middle ear infection can result from a serious cold with congestion. A middle ear infection often clears itself up within 5 days, but if you have had symptoms of pain and pressure in your ear for 5 days or longer, you should visit your GP as oral antibiotics may be necessary. If we find that you have middle ear congestion, we will recommend you try using Sterimar, ear clearing techniques or a combination of the two.

Can Microsuction Cure My Tinnitus?

Recent statistical research has shown that 9 out of 10 people with tinnitus also have a hearing loss. Most theories of tinnitus believe that tinnitus is caused by hearing loss. For people with tinnitus and a long standing hearing problem, typically 70% will find that hearing correction will be sufficient to make their tinnitus either imperceptible, or so low as to no longer be bothersome.

Ear wax can cause a temporary hearing loss in its own right, or temporarily exacerbate a pre-existing hearing loss. If the tinnitus began after the ear wax blockage, then there is a very good chance that removing the ear wax blockage will make the tinnitus go away or at least be so low as to no longer be bothersome. The likelihood of success is greater the less time the ear is left blocked without treatment, as the brain is more likely to start making changes to compensate for the hearing loss the longer the ear remains blocked.

Some people feel that their ears are blocked, but in fact don’t have any ear wax blockage at all and it turns out they have a hearing loss that just crept up on them. In these cases, we have a tinnitus practitioner who can perform a hearing test and fit the latest combination tinnitus treatment devices.

Can I Get Free Microsuction On The NHS?

Microsuction is available for free on the NHS, but not everyone qualifies. Just like all NHS treatments, your GP will weigh up the cost versus the benefit, and may recommend using olive oil, then sodium bicarbonate, then urea peroxide ear drops for up to 6 weeks before agreeing to refer you to the local hospital for microsuction. Due to the lack of trained, qualified practitioners, many hospitals have waiting lists ranging from six weeks to six months. Having to wait 12 weeks or more being unable to hear is frustrating to say the least, and many people choose to go private and self-refer to a private microsuction ear wax removal clinic, such as one of ours.

Can Children Have Microsuction?

We have two age ranges for children:

  • Infants aged 5 to 11, and
  • Under 18s, aged 12 to 17

These appointments are more expensive that an adult appointment, because it is more challenging for our practitioners, both in terms of the narrowness of childrens’ ear canals and/or in their behaviour.

As a parent or guardian, you will need to be present during the appointment, as you will be required to consent to the procedure on behalf of your child. Remember that while microsuction is considered to be the safest method of ear wax removal, like any medical procedure it is not entirely risk free. You will need to weigh up the risk versus the benefit. For instance, is the ear blockage causing your child to fall behind in language or educational development?

In order for the procedure to be carried out safely, your child will need to sit still, either on their own or on your lap. They will need to keep calm and keep their arms and legs still, so as to avoid any risk of self-injury. We always put your child’s safety and safeguarding first, so if they cannot stay still, or become agitated or distressed, we will stop the procedure, allow time for our practitioner or yourself to calmly talk to your child, and if your child can calm down, and at our practitioner’s discretion, make a second attempt at completing the procedure.

About Micro Suction Ear Wax Removal

nmc registered ear wax removal microsuction professional copyright 2015 earwax removal dot net jason levy

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What Is Micro Suction?

Micro suction earwax removal is the removal of ear wax from the ear using a medical suction device under the microscope with illumination.

Who Can Perform Micro Suction?

A Micro Suction Practitioner must be an appropriately trained, registered and insured professional. Typically microsuction is performed by a Doctor, ENT Surgeon, Specialist Nurse or Audiologist. Our clinics are staffed by Specialist Nurses and Audiologists.

How Safe Is Micro Suction?

Micro suction introduces no water into the ear and only removes wax from the ear using gentle suction. The Micro Suction Practitioner uses a pair of operating microscopes known as “loupes” and a bright light to see into your ear canal in great detail. This way, he or she can see exactly what they are doing inside your ear. The suction wands are sterile, so the risk of infection is virtually nil. For these reasons, microsuction is considered the safest method of removing wax from the ear.

Does Micro Suction Hurt?

Our Micro Suction Practitioners are highly trained, and will gently draw the wax from your ear using a CE-certified medical suction pump. We recommend that you use a couple of squirts of Earol sterile olive oil spray, or a few drops of olive oil in either ear for a few days before your appointent, and the procedure is painless.

How Soon Can I Be Seen?

We recommend that you use a couple of squirts of Earol in either ear for a few days prior to your appointment, but if you have already softened the wax we may be able to see you sooner, depending on how busy our clinics are.

Where Can I Get Microsuction?

We have a number of private ear wax removal clinics. Please visit our ear microsuction locations page for further details.

How Can I Book A Microsuction Appointment?

Cllick on the “Book Now” button below, or click on the link to the booking page.


I’ve Had Ear Surgery And Can’t Get My Ear Syringed – What About Micro Suction?

After ear surgery, you may have been told to keep your ear dry and never have it syringed (irrigated), as there may be a risk of perforating your ear drum or causing an infection. Fortunately, micro suction doesn’t introduce any water into the ear, and providing that your surgery has healed there should be no problem. As always, please check with your surgeon that he or she is happy for the procedure to be carried out.

I Have A Perforated Ear Drum And  Can’t Get My Ear Syringed – What About Micro Suction?

The same applies as for the previous question. However, we recommend that you don’t use any ear drops or sprays prior to your appointment. Micro suction or dry instrument removal are the only two methods that are recommended if you have a perforation or have had ear surgery.

What Is The Difference Between Microsuction And Endoscopic Earwax Removal?

Microsuction is the removal of ear wax using suction and either the operating microscope or surgical loupes. Normally a 2mm Zoellner tube is used, but a 1.3mm fine end may be used when working close to the ear drum. Endoscopic Earwax Removal is the removal of earwax using an otoendoscope or video-otoendoscope to view the ear canal and ear drum, and various removal tools such as suction, the Jobson Horne probe, earwax hook, or crocodile forceps. Each method requires different skill sets and further training under an ENT consultant is recommended if ear wax will be removed endoscopically.