Microscopic and microsuction ear wax removal is a procedure where ear wax is removed from the ear under a microscope. The microscope is used to directly visualise the ear wax whilst it is being removed using either ENT micro-instruments (e.g. ear hook, jobson horne) or gentle suction with a low pressure suction machine and fine sterile probe (microsuction).


The procedure is traditionally performed by ENT doctors or nurses via the NHS using high-magnification binocular operating microscopes, although there is a growing number of private Audiologists and Hearing Aid Dispensers in the UK now also performing microscopic and microsuction ear wax removal using magnifying glasses (loupes). Loupes are limited in the terms of both the magnification and distance (depth) of view they can provide inside the ear. However they remain popular due to their portability and relative inexpensive compared to an operating microscope. Both operating microscopes and loupes provide stereoscopic vision which aids depth perception.

Microscopic and microsuction ear wax removal typically takes between 15 to 30 minutes to perform. This can vary depending on the amount and type of of ear wax, how deep the ear wax is inside the ear canal, if ENT instruments or microsuction is being used and whether you are having one or both ears treated. It is usually performed with you laying down on a bed with your head titled to the side so that the ear with ear wax can be accessed. A bright light and ear tip (speculum) inserted into the ear are used to help see inside the ear.


Unlike ear syringing or ear irrigation, where ear wax is flushed out ‘blindly’, with microscopic and microsuction ear wax removal the ear wax is being directly visualised under the microscope whilst it is being removed. This makes the procedure much quicker, safer and comfortable for the patient. Other benefits of microscopic and microsuction ear wax removal include:

  • There is not always the need to apply ear drops for wax (e.g. olive oil or sodium bicarbonate ear drops) for several days or weeks beforehand, which is the case with ear syringing or ear irrigation. Nonetheless, the use of ear drops is still recommended where ever possible for one or two days prior to having microscopic and microsuction ear wax removal performed.
  • No water is being flushed into the ear canal like for ear syringing or ear irrigation. Instead the procedure is performed ‘dry’ significantly reducing the risk of infection and accidentally ‘pumping’ ear wax deeper into the ear canal.
  • Unlike ear syringing and ear irrigation, it can be performed in people who have a perforated eardrum or grommet, mastoid cavity and cleft palate, in addition to any foreign object (e.g. children’s marble) that may be lodged inside the ear canal.


A limitation of using operating microscopes (or loupes) to remove ear wax is the view provided is quite narrow. As a result the position of the microscope, speculum inside the ear and the person’s head can require constant re-adjustment in order to refocus and visualise the ear wax. Despite this, microscopic and microsuction ear wax removal is regarded as being safe and well tolerated. However no treatment of ear wax is completely ‘risk-free’. Some of the risks and side effects of microscopic and microsuction ear wax removal include:

  • Damage and trauma to the ear canal and eardrum (including perforation).
  • If microsuction is being performed a loud noise can be generated in the ear canal due to the suction. In some people this can cause hearing loss (temporary or permanent) and tinnitus (ringing type noise inside the ear) or worsening of it if already experienced. This is rare.
  • Microsuction ‘cools’ the temperature inside the ear canal which can lead to faintness, dizziness or vertigo. This is due to the ‘caloric’ effect and is normally short lasting.
Video: Mr Rejali (Director and Consultant ENT Surgeon) demonstrating how microsuction is performed
Image: High-magnification binocular ENT operating microscope