The Dangers of Microsuction

It's horrible to hear accounts of people's lives being ruined by a simple procedure like microsuction. There hasn't been that much work looking at any dangers:

Suction-generated noise levels during aural toilet].
Hansen S, Stupp A, Schwarze S, Schipper J.
Laryngorhinootologie. 2012 Feb;91(2):103-8. doi: 10.1055/s-0031-1295464. Epub 2012 Jan 4
Clin Otolaryngol. 2009 Feb;34(1):21-5. doi: 10.1111/j.1749-4486.2008.01841.x.

Noise levels generated within the external auditory canal during microsuction aural toilet and the effect on hearing: a prospective controlled series.
Snelling JD1, Smithard A, Waddell A.

I would think it is quite rare to cause problems though. I made a rough calculation of the number of times I must have performed this procedure - about 10,800 is my conservative estimate and I don't know of any cases of causing T/H. I do know one extremely experienced and world renowned colleague who did have this happen to them with a patient. It's so hard to put a figure on the risk. Normally doctors should quote you risks of anything known to occur 1 in 100 times (or more) if the complication is not severe. Severe risks such as death/disability should be explained though even if they are much rarer.

 

@brownbear what are your thoughts regarding micro suction on people with T, H and even acoustic shock? Safe?
I was assaulted with this when I went in for a consultation regarding acoustic shock (in addition to the T and H) and it was after explaining my symptoms. I thought he was just going to take a look but instead he did this for a tiny amount of cerumen (which is normal anyway!). He then had the nerve to give me a hearing test after blasting me with that horrible suction noise. His stupidity astounds me as much as my own for letting it happen.

And now you are on this side of things, would you still have the procedure performed on yourself?

 

I had my ears cleaned by microsuction, and immnediately afterwards in my left ear human speech sounded like Donald Duck. I could understand nothing if the voice was predominantly in my left ear. The audiologist clearly didn't have a clue, and didn't want to know. He just said it would get better, and left me to struggle on alone. It took over six months to clear up, and I lived through a nightmare. If you look on other sites, people report robotic voices and wah-wah voices, which is presumably the same thing as I had. It is very easy for people to say that microsuction is safe, because there does not seem to be any way to report the side effects; what is needed is the equivalent of a Yellow Card scheme for medical equipment. How can anyone know it is safe if there is no reporting system? I am about to contact Jeremy Hunt to suggest a system.
A friend of mine had microsuction, and it left her with tinnitus for life in one ear. We must not allow the manufacturers to get away with this.

 

Hi @judith77

If you contact Jeremy Hunt about this subject, please le me know how you get on. Thank you

 

Blue 28: Having done more googling, I have found that this distortion of noise also occurs in people who have not had microsuction. This condition does not seem to be recognised by audiologists, as far as I can see. I have emailed Action on Hearing Loss to see if they can shed any light; if not, a letter to Jeremy Hunt. I will keep you posted.

 

Thank you @judith77

 

Brown bear are you an audiologist?

 

@brownbear does not seem to want to answer questions that are quite important to many of us here. It’s a shame. I was hoping he was different to most other ENTs, considering he is also a fellow sufferer.

 

Hi @Gman. Sorry I didn't reply. I must have missed your message. I don't check in that often. I agree that taking out small amounts of wax is not usually a good idea. Maybe they wanted a better view of your TM. I have had it done a few times since I got T when I had intratympanic steroids with no problems so yes would probably have it again if I had to. Some people prefer manual methods of wax removal which works well for T cases.
I suppose with regards to its safety - maybe it's like flying? You're never totally safe.

@Agrajag364 , no I'm an Otologist.

 

@brownbear Thanks. I’m sorry if my post above was a bit harsh.

 

@brownbear Thanks for your reply. I have been thinking a great deal about what might be the true risks of microsuction for some months now and have read most of the available literature including the papers you mentioned. There are also german papers and reports of litigation in Germany over suction causing tinnitus. One ENT gave me the same figure you quote, roughly- that he'd done this procedure in 1000 or so patients and he said none had got worse. But I do notice there are quite a lot of people on here who found microsuction did make their tinnitus worse or who got their tinnitus through microsuction. Even allowing for the fact this is a frequently performed procedure, this does not quite add up. When the question is posed there seem to be more people on this and on facebook tinnitus forums who found suction did not affect their T than those who found it did, but not by much. Also with the decibel levels given in some of the papers on the procedure it would really be surprising if the procedure did not worsen some people given that one off acoustic trauma from similar sorts of decibel levels seems quite a common cause of T. I had a surgery go wrong and got quite involved in looking at how outcomes of procedures are audited- not well, is the answer. I do think medicine has a bit of a problem with a lack of logging of adverse reactions to procedures.

I have a question for you which I hope you won't mind answering. You mentioned you've done 10,800 suction procedures and you don't know of any cases of causing T or H. In what rough proportion of those cases would you say you saw the patients after the procedure?

I appreciate that any damage from suction might be linked to the skill of the practitioner and that some practitioners may have very low rates or no cases of worsenings of T. But I also think it's quite feasible that some people get worse T post suction and don't report this back to the practitioner if they are not booked in to see him or her again?

 

Hi @Gman , your post wasn't harsh, don't worry. We are all frustrated as hell. I find I slip back a bit when I spend time on here so sometimes miss things.

@Agrajag364 . You are quite right that many people are not seen again. Not sure what percentage. So certainly my anecdotal experience is only worth so much. Would have thought that if I had left anyone with devastating T then they might mention it! Suppose I'll never know as there are insufficient resources to check on everyone. I can say that I also don't see new T patients that have already got T from microsuction done by others. I do see quite a lot whose problems seemed to start after syringing though.
Most responsible surgeons should audit their results and discuss complications with colleagues at monthly morbidity meetings.

 

You also have to consider all the people who rely on ear cleaning to stop conductive overlay from wax worsening their T.

It's such a basic procedure that I'm not sure skill comes into it that much. Personally I always ask people to tell me to stop if either the noise or sensation is painful. It's not life saving stuff so always best to stop from my point of view.

 

@brownbear Thanks for that. It's interesting to hear your say you see patients with T that started after syringing but not patients with T that started after microsuction. I emailed a no. of ENTs about the relative risks of worsening T with each method of ear wax removal and whilst some simply said microsuction would not risk worsening it and left it at that, others said microsuction was the most likely procedure to worsen tinnitus of all the wax removal methods, and water irrigation was less likely to do this. The distinction seemed to be drawn between removal of wax with an actual syringe (a method which was frequently used in GP surgeries in the past in the UK but is not longer use) and removal of wax with water irrigation using a machine (meaning the water went into the ear under less pressure). However I have noticed that the term "syringing" is often used to cover both old fashioned water syringing and also more modern irrigation.

Do you think these patients you see with T induced by syringing had actual syringing, or more modern water irrigation? I appreciate it may be impossible to tell if the term "syringing" is often used to cover both methods.

Reason I ask is it was a wax impaction which set my tinnitus off 3 months ago. I got the bulk of the wax removed manually by an ENT but subsequently an audiologist and another ENT told me I had quite a bit of wax still on my ear drum and there was a chance that was contributing to my ongoing T. As I understand it it's not that safe to take wax of the eardrum using tools which I guess is why the first guy didn't do it.

 

@brownbear @Agrajag364

Microsuction is the cause of my severe tinnitus, hyperacusis and high frequency hearing loss... No doubt about that for me. I had no tinnitus etc before. The procedure was very loud with high pitched squealing from the suction tool, I mentioned this to the ent but he didn't seem bothered so I thought it was normal for it to be like that. I reported my symptoms to him within days of the procedure and I even went back multiple times to the ent to try to get answers... He was only interested in saving his own skin and even said my tinnitus was caused by a depression or stress I must have had before WTF!!! It's disgraceful that this is happening to innocent people, and disgusting that the medical professionals doing damage are getting away with it!!! My life has been completely ruined by this procedure, or the lack of care/knowledge of the person performing it.

 

So sorry about that @Blue28 . What frequency is your high frequency hearing loss? I was admin on a group of over 5000 harmed by a particular surgery. What we saw was that it was extremely frequent for people to be told that symptoms which started directly after surgery were not as a result of the surgery. We speculated this was partly a medical legal defence tactic

 

@Blue28 another thing to say is that I recently came across two people whose T started with ear wax and got far worse after ear wax removal using syringing/irrigation (not clear which). But eventually both improved alot, one to the point where she feels the T is almost gone. So there's always a chance things will improve for you. T from ear wax removal using water may be more similar to T from suction than you'd think- I was told by an audiologist that the damage from the water hitting the eardrum mimics the damage from acoustic trauma. The drum is not meant to be moved much.

 

Hi @Blue28 . That sounds awful. I'm so sorry this has happened to you.
Not sure if it helps but I think it is more likely the procedure than anything to do with the level of care or knowledge.

 

Thank you @Agrajag364 and @brownbear

At 12khz my hearing takes a huge drop... -65dbhl. There are also some small dips (10-20dbhl) at a few other frequencies up to 8khz. My very intrusive tinnitus was measured at 12.5khz. It's unreal how a standard ENT procedure can damage hearing!

@Agrajag364 I believe you're right about the medical legal defence tactic... Shocking! I really hope what goes around comes around!

 

My T started after using ear wax drops whilst having impacted wax in both ears. It switched on suddenly and never switched off.

I have had microsuction three times within the past year and a half and, apart from the third time, for a decent amount of wax. First two times I didn’t have any issues as the ENT was able to get a good seal on the wax without any clarinetting.

The third time mentioned above was with acoustic trauma and H, there was clarinetting due to the fact there was very little wax - so a good vacuum seal wasn’t possible. It didn’t do my H and T reactiveness any favours, that’s for sure.
I don’t think it has increased my overall T level though.

I would say there’s a skill to it and not all ENTs are equal. It requires speed, control and knowing how to avoid or minimise clarinetting. Plus having some common sense (a rarity) helps to determine if the patient needs it. Some so called doctors just want to make money out of the vulnerable.

In my pre T days I had syringing maybe three times in maybe 15 years and never had any problems. Once again comes down to how good the dr is, I guess.

 

@Gman how did you find that stuff out about how clarineting can be minimised? Did an ENT tell you or did you read it somewhere? If the latter could you possibly link to it please?

 

From experience. If there’s enough cerumen to get a decent seal quickly then it’s going to be less noisy than trying to get a seal on smaller bits, which is going to cause clarinetting.
In retrospect, the ENT I saw the first two times was able to do this well. The second was an impatient moron who just hoovered without much skill.
The camera is good in that you can evaluate how good/bad they are first hand. They should give patients a video so then you can use as evidence for a lawsuit if things go badly.

 

Hi I just wanted to chime in and say that this happened to me aswell, the procedure itself was loud but not too bad but there was a breif second when he was suctioning my right ear where it sounded like a loud bang followed by a high pitched whistle almost, it was so loud I physically jolted and had to yell at him to stop.

 

Sorry to hear that this happened to you too @Liam_Cairns. It's shocking that this procedure is carried out without warning people of the possible dangers. Do you have tinnitus /hyperacusis /hearing loss following the microsuction?

 

I️ believe this same thing has happened to me. I️ went to a new ent for a hearing check up on July 22nd as I️ had mild hearing loss in 2014 and hadn’t had an updated check since 2015. I️ was not informed that there were any dangers nor was any pre-prep done...such as ear drops, olive oil, etc. the microsuction was performed and kind
Of hurt a little as well. All was ok on that day, but 3 days later while sitting at home my
Hearing dropped and I️ began having tinnitus. I’ve now seen 3 specialists and the best remedy for my hearing loss is a cochlear implant which my specialist said I️ have about a 20% chance or
Receiving approval for thru insurance since I still have only mild hearing
Loss in my right ear. Not only am I️ beginning to suspect the tinnitus was caused by the microsuction but also the drastic loss of hearing. I️ just can’t see it being a coincidence. Especially after all the research I’ve been doing. I’d love to hear what thoughts y’all have!

 

You have mild hearing loss in the right ear, and what about the left ear?

 

So what is the best method to prevent wax from building up or to get it out? I’m so reluctant to get syringing or microsuction again, yet I tend to get cerumen build up quite quickly. Using ear plugs worsens it as they push it back down the ear canal, eventually leading to an impacted plug.

 

Hi @Libfuller. So sorry to hear you're another victim of microsuction, this is terrible. I'm outraged that this procedure is undertaken with such little care and attention, and that ENTs either don't seem to know of the dangers or don't want to admit they exist. I feel very strongly about this as microsuction has ruined my life, yet the ENT who performed the procedure denies all responsibility. I feel I need to make the authorities aware of the possible dangers of microsuction so that patients can at least be informed and make their own decision whether to proceed or not.

 

Hi @Libfuller

I am very sorry to know of your experience at ENT and having microsuction. There is a right and wrong way for this procedure to be carried out. You should have been advised to apply eardrops, using a pipette 3 times a day to each ear for up to 10 days prior to having the microsuction done. This will usually soften the wax enabling it to be easily removed. This also applies if one is going to have the wax removed by ear irrigation or manually removed by "tools" using a curette.

Unfortunately this information is not always told to the patient. I have read on the Internet where private practices advertising their services for microsuction. Telling people there is no need to soften the wax using ear drops before having it done. Other clinics say use eardrops for 3 days or the night before. Totally wrong, inept and unprofessional. People have contacted me saying they went to a clinic and had earwax removed using microscution and were told, eardrops are not needed and ended up with tinnitus afterwards. When they returned to complain, they were brushed aside and told: "none of our other patients" have had any problems.

Even if one uses eardrops in the manner that I've suggested, there is no guarantee that problems wont occur. This also applies whether irrigation is used or curette. Having earwax removed is a medical procedure. A small one and minor some would say, but it can cause serious problems when it goes wrong as you have described. I have had microsuction 3 times and ear irrigation the same and had no problems. I used eardrops for 10 days prior to having the wax removed. I admit I could have still ended up with problems but fortunately I didn't and my tinnitus can reach quite severe levels as I take clonazepam occasionally for it.

I want to make a few things clear. Under normal circumstances ear wax exits from the ear by natural means and doesn't require a visit to a GP surgery to have it removed by ear irrigation, which is the common method used today. However, when a build up occurs it needs to be removed because it can cause problems: Hearing loss, tinnitus, infection, severe pain in the ear, fever, dizziness and the list goes on.

It is very difficult to prove negligence and malpractice against the medical profession. They can afford the best lawyers and one has to have very deep pockets and proof to go up against them and most likely they will lose. I occasionally do tinnitus counselling by telephone voluntarily. Someone contacted me a couple of years ago after having deep root canal work done on three of his teeth. His tinnitus increased to very severe levels and got so bad he wanted to end his life. He spent £7,000 trying to take his dentist to court and had to drop the case when he couldn't find anymore money to pay his lawyers. They milked him dry and were only in it for all they could get.

Michael

 

Hey guys

There's a chance that my tinnitus is caused from a piece of wax lodged and impacted into my left ear drum.

I have an appointment to go from canada to mayoclinic at arizona- they said that physician assistants with subspecialty to ENT surgeons/surgery carry out microsuction/manual removal, and that they do not have irrigation there, and that I have to fly in for an appointment for any more information regarding risk disclosure because they refused to tell me more information over the phone (It's ok were still on good terms).

Also, they said the person doing the wax removal will be whichever physician assistant is available for that time/day that their called for.

IMPORTANT: I already have other serious health problems, and even in already acclimatizing to tinnitus, I am doing my best to balance mitigating the risk of suicide in the coming future with trying not to rush into getting microsuction from some cowboy who does not appreciate the risks involved/liability- as I believe the wax was originally impacted from tests at an audiologist/ENT in Canada from me not doing due diligence and rushing into letting someone close to my ears that I shouldn't have

As of this morning my plan is:

1) Fly to mayo in arizona in 1.5 weeks regarding wax removal appnt I have
2) Speak with the physician assistant randomly assigned to me for that time
3) Since I have decided upon manual removal with a curette ( not microsuction ), I will;
4) Ask them if they can attempt to remove the wax manually with no microsuction
5) If they agree to only using a curette, not microsuction, I will confirm with them that they can see into my ear the entire time the same way they see into your ear with microsuction
5) As of right now, I am thinking that if they refuse and only want to use microsuction, I will decline and fly back to Canada

6) If they agree to attempt to remove it manually with a curette, there is still not a guarantee everything will work
7) They may remove the wax in one fell swoop, pulling it all out because it dosn't break apart - a success, OR;
8) They may say they cannot get impacted wax off the drum manually without suction or, it's too dangerous to use the curette that close to my ear drum so they'll want to use suction
9) At this point, I can accept that manual extraction has failed, and now I have to consider microsuction

I have 3 options here

Option 1) Leave the impacted wax in, continuing to use olive oil for however long, with no guarantee of getting the impacted wax out- and leave myself to my current deteriorating mutilated quality of life state which is not sustainable, and the risk of suicide will continue to rise rapidly, essentially betting with my life as a stake

Option 2) If I trust the physician assistant with me at mayo, roll the dice and, in letting them proceed, just hope I judged well that they're not a cowboy with the microsuction and that everything turns out Ok. - This one scares the hell out of me, I'm betting my life with this option as well

Option 3) If I think the microsuction is dangerous at mayo, decide to get microsuction elsewhere, and roll the dice elsewhere with microsuction, or find someone else and risk manual extraction that close to my eardrum, which is why I have sought out this thread in this forum; and come to you guys;

@Blue28, @Michael Leigh, @Gman and anyone else, is it Ok if I ask for your guys input or what you think about stuff

Also I can/am thinking of postponing going to arizona for another 4 weeks if I change my mind/decide I need more input into my decision/decide to go elsewhere first but I can't find anyone yet; I've already read that clarinetting can cause decibals as loud as a gun shot beside an unprotected ear - this link would be my dream procedure if it turns out i do have wax impaction aside from this guy maybe being a cowboy who didn't ask to soften the wax with drops for weeks prior - just the way that it manually comes out without ever having to touch the ear drum I mean is what I would want,

2:35 is where you can see the blood which I assume is from the free'd impacted ear drum, -

Hard Impacted Huge Ear Wax removal in one stroke