EAR SYRINGING AND TINNITUS

Quite a number of people say that their tinnitus began or was made worse after having their ears syringed. However, the majority of patients suffer no adverse effects or complications.

Opinions appear to vary over the risks involved by ear syringing. Injury to the ear is usually because of insufficient care and knowledge on the part of the person performing the procedure. Surveys have found that only a small percentage of GPs supervise or perform the syringing themselves. Most delegate the procedure to practice nurses, some of whom had received very little or no training in the subject. A small number of doctors were not aware of whether their nurses had received student instructions to carry out this treatment. Ears were rarely examined again after syringing.

Syringing carried out correctly where the ear and eardrum is healthy should not, in theory be a problem. So why then should things go wrong? The worst injuries stem from faulty syringes causing damage, not only to the eardrum but the bones in the middle ear and sometimes in the inner ear. More common than this is the excessive force of water, which can rupture the eardrum, which may already be weakened by earlier ear problems.

Since the syringing can develop very high water pressure, this force could well be sufficient shock to the hearing mechanisms to start or increase tinnitus. The volume of noise, which may be produced during this treatment, may also be sufficient shock to induce tinnitus. In the worse cases of physical damage, penetration of the eardrum and infection can occur and it is quite conceivable that tinnitus may start or get worse.

When there is no rupture, no damage or mishap, and the procedure has been carried out with the utmost care by someone fully experienced and trained, yet tinnitus starts or appears to increase in volume. What can have happened?

One theory is that there is already an underlying hearing impairment and that there is a sensitivity or susceptibility to developing tinnitus, which would ultimately become apparent. The syringing merely brought forward the onset of this condition. This is indeed poor consolation, to be told that developing tinnitus in the future was a possibility, and that you have developed it prematurely by having your ears syringed. If this were the case, would it not be advisable for those with 'susceptible ears' to avoid syringing if at all possible?

It is a misconception that earwax (which is produced naturally) needs to be removed. It is quite usual for ear wax to fall out by itself and a large percentage of wax removal would not be necessary if people did not push and poke foreign objects such as cotton buds, hairpins etc down their ears. This only compounds the wax, creating possible infection and other problems such as tinnitus.

There are times however, when syringing is necessary and will be helpful, but it is important to be aware of guidelines, which will help to avoid any problems.

Doctors should be told of any known ear complications, which they may have, which may present a risk from syringing i.e. any previous infections, existing tinnitus, hearing loss, weak, or perforated eardrum, previous syringing or surgery.

Doctors should be aware of the need for experienced operators for this procedure and not put patients at risk by delegating it to others who may not have adequate experience or knowledge. The busy lives of doctors however should be taken into consideration. Awareness and knowledge of their own problems is most important in helping the doctor to decide on the best possible procedure of treatment, especially when dealing with the sensitive mechanism of the ear.

Finally even a correctly performed ear syringing on a healthy ear may endanger or worsen tinnitus. It cannot be stated too often that it would be wise to consider alternative procedures, such as using wax-softening agents, and to look for reasons for wax build-up.

Tinnitus caused by ear syringing is not a great risk if a fully qualified practitioner carries out the procedure correctly, on a suitable patient.

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