Cerumen removal is increasingly becoming an essential clinical service for audiologists and audiometrists. Once largely confined to hospitals, ENT clinics, GP surgeries and nurse-led services, the procedure is now firmly establishing itself in hearing care practices.
For many hearing care practitioners, the shift to incorporating cerumen removal reflects practical necessity and growing patient demand. Ear wax can obstruct hearing aid fittings, compromise hearing assessments and mask underlying pathology. At the same time, more patients are seeking fast, safe and convenient solutions for blocked ears – and increasingly expect audiologists and audiometrists to provide them.
Melbourne audiologist Mr Keith Chittleborough, who has been at the forefront of the cerumen removal revolution for one and a half decades, believes ear wax removal should be considered a core skill for anyone working in the profession.
“I don’t think you’re an audiologist unless you can do it – you’re basically selling yourself short,” he says. “I don’t think you own the ear unless you’re doing ear wax removal.
“Audiologists and audiometrists need to be responsible for what’s happening inside the ear. It’s our space, we’re the best suited knowledge-wise to supply wax removal and triage the diagnostics that people require.”
With new technologies emerging, growing training opportunities and innovative service models such as mobile ear wax clinics, cerumen management is evolving rapidly – and may represent one of the profession’s most accessible opportunities to expand patient care, offering a complete service, and an opportunity for additional income.
For clinicians with access to diagnostic tools, it can also be an important opportunity to identify serious conditions that might otherwise be missed.
SSNHL trend
Chittleborough says one of the most concerning trends he’s noticed recently is sudden sensorineural hearing loss (SSNHL) disguised as ear wax blockage. He says he can’t remember how many times he has discovered sudden hearing loss during an appointment for wax removal – and immediately referred the patient for urgent treatment.
“In the winter of 2025 I was detecting it almost weekly,” he says. “These low-frequency hearing losses need urgent care and prednisolone. Audiologists can write a quick report, so the patient sees a GP that day or attends a hospital and receives steroid treatment.”
Early treatment is critical as delays can affect outcomes. Chittleborough believes audiologists are uniquely positioned to detect the condition early because they have access to audiometric testing.
“People who don’t have access to an audiometer will leave it for a few days to see how it feels,” he says. “This is our space – I think we’re safer in terms of our diagnostic capacity.”
He says performing a quick audiogram and tympanogram after cerumen removal can reveal issues that might otherwise be overlooked.
“I just do that quick audiogram/tymp and have a longish appointment time and a highish price – to ensure I pick up these things, or if it’s a fungus or something like that, you need to get a good report to the doctor,” he adds.
Beginning with Lyric fittings
Chittleborough’s journey into cerumen removal began about 15 years ago while fitting Lyric extended-wear hearing aids with audiologist Dr Brooke Hanby. To gain Lyric accreditation, practitioners needed to learn how to use a medical microscope and ensure the ear canal was clear before inserting the devices.
“We were aware that we needed ear canals to be clean and we also had to deal with previous injuries,” he says. “The only way to remove wax or debris from injury is via microsuction.”
At the time, cerumen removal was rarely performed within private audiology practices.
“No-one in the private audiology space was doing cerumen removal in 2011 – only hospitals and some startup nurse clinics,” he says.
Dr Hanby enabled Chittleborough to buy equipment through Phonak, allowing them to begin performing microsuction. “We pretty much self-taught ourselves,” he says.
He’d previously learnt curettage, and over the years has undertaken several cerumen removal courses, including the VorOtek training program.
Even in those early days, he believed the service would eventually become an important component of audiology practice. “I knew cerumen removal would be massive – that we’d be able to charge for it and it would be an incredibly valued service that would bring in new customers. It’s a no-brainer.”
Today he performs cerumen removal at Victorian Hearing clinics and teaches ear wax removal through Ear Health Courses, owned by Dr Hanby.
Practice builds proficiency
While most audiology students now learn the basics of cerumen removal at university, Chittleborough says clinical practice is what truly develops competence. “Students are taught cerumen removal at university but practise in clinics is what builds the skill set,” he says.
Beyond standard practice, clinicians have the option of upskilling to utlilise medical microscopy. . “Medical microscopy is hard compared to what we’re used to doing,” he says. “But once you get used to this gold standard, you can see everything.”
Training courses typically combine theory with hands-on experience. Ear Health Course’s program includes practical sessions where participants practise on each other and, sometimes, Chittelborough’s ears.
The course uses creative training tools to simulate different wax conditions. “For soft wax we use cream in ears, and for hard wax we use sultanas,” he says. “A dome is placed inside to practise using forceps.
“It’s important for people to experience what it’s like on themselves first – how it feels, how it sounds. Suction is noisy. It sounds like a plane, and that’s one of our biggest risks – managing noise.
“One phrase I bang on about is ‘skin in the game’. Students should undergo the procedure themselves to understand the patient perspective.”
Choosing the right technique
Modern training usually covers microsuction, curettage/manual removal, and irrigation. Each method has its place depending on the condition of the ear and wax type, he says.
Chittleborough says microsuction is often considered the gold standard because it allows clinicians to remove wax under direct visualisation. “The beauty of microsuction is a practitioner can grab a lump of wax centrally and lift it out without necessarily having to go near the canal walls,” he says. “That means avoiding touching the delicate skin and causing potential trauma.”
Curettage can still be useful, particularly when wax is hard or impacted. “The probability of touching the ear canal walls is higher with curettage, but sometimes it’s needed if wax is hard or stuck,” he says.
While irrigation is becoming less common due to potential risks associated with direct water pressure, Chittleborough occasionally uses a low-pressure water spray to clear debris.
“I probably use a spray water bottle once a month,” he says. “It doesn’t apply direct pressure but can help flush out extra debris and get everything off the tympanic membrane if intact. Perforation risk is low because the pressure isn’t there.”
New technologies
The cerumen removal equipment market has also expanded significantly in recent years.
When Chittleborough began performing the procedure, options were limited. Today, clinicians have access to a wide range of microscopes, endoscopes, digital otoscopes and suction systems.
Established tools include VorOtek’s head worn O Scope microscope and vision equipment, along with suction pumps and specialised removal instruments. More recently, new devices have entered the market such as the WAXScope, developed by British audiologist Mr Neil Raithatha, and the Audelation OWL lightweight otoscope from the UK.
Chittleborough believes digital visualisation will play an increasingly important role.
“The cutting-edge design space is in the digital field,” he says. “Even the normal digital otoscope should be a standard part of ear wax removal.”
Being able to show patients images of their ears also improves engagement. “I like to take pictures on my screen before and after to show them,” he says. “It’s a value add and a bit of theatre.”
Patients often want to see what has been removed. “They didn’t used to, but many want to take a photo of it now,” he says.
Future possibilities
Chittleborough believes visual technology could evolve further. He would like to see virtual reality glasses linked to otoscopes, allowing clinicians to work with a larger field of view.
“The bigger the vision the better, and the less bending I have to do, the happier I am,” he says. “Cerumen removal can be tough on the back.”
Improving ergonomics may become an important design priority as more clinicians perform wax removal regularly.
Beyond its clinical value, cerumen removal is increasingly recognised as a powerful business driver for hearing clinics.
“Wax removal is good for social media and for referrals,” Chittleborough says. “I don’t think we stress how good wax removal actually is for referrals – new clients coming in.”
Blocked ears often create immediate discomfort, prompting patients to seek help quickly. When clinicians resolve the problem instantly, satisfaction levels can be high. “These patients are always very happy and obliging to give a good Google review,” he says.
“It feels good – they come in with a blocked ear or pathology; you remove it and they’re so happy.”
Many patients also return periodically for maintenance. “They come back in six months or a year,” he says.
For new practices, wax removal can be a valuable service for building a client base. “It’s a massive driver for new patients,” Chittleborough says. “If you’ve got a startup clinic, cerumen removal will bring in new clients and get revenue going.”
Risks of DIY ear cleaning
While demand for professional cerumen removal is increasing, many clinicians continue to see complications caused by do-it-yourself ear cleaning, he adds, with cotton buds remaining a common cause of problems.
“Everyone knows they’re not supposed to put cotton buds in their ears – but perhaps not everyone does know!” he says.
More recently, online retailers have introduced consumer ear cleaning devices, including inexpensive otoscope tools sold through platforms such as Amazon. “People are buying B-bird otoscopes and causing injuries,” Chittleborough says.
“We’ve had people come in with their ear all torn up because they’ve been doing wax removal themselves.”
These injuries reinforce the importance of professional services by trained practitioners, he adds.
Mobile service
While many clinics provide in-practice wax removal, some audiologists are having great success exploring alternative service models. One, Sydney audiologist Mr Mo Helou, has developed a mobile service that brings cerumen removal directly to patients’ homes and aged care facilities.
His business – Mobile Earwax Specialist – has treated more than 5,000 patients or 10,000 ears in just over three years.
Helou’s interest in audiology began while studying medical science at Western Sydney University, where he realised the field offered opportunities to help people while building a growing career.
He completed a Master of Audiology at Macquarie University, although the COVID-19 pandemic disrupted much of his practical training. “We did the course online and didn’t get to do as much practical work through an internship,” he says.
After graduating, Helou joined Bay Audio, and despite the shortened internship, received Rookie Clinician of the Year in his first year out of 130 clinicians. While at Bay Audio, Helou noticed many patients asking about ear wax removal – a service the clinic did not provide at the time.
“I thought I could do more to help these people,” he says.
In November 2022, he launched a small mobile service providing ear wax removal on weekends while he was still working at Bay during the week. “The point was to do ear wax, and I thought I would send those patients back to the Bay Audio clinic for other conditions,” he says.
But once he began visiting patients in their homes, he realised the relationships were deeper than he expected. “They trusted me and were letting me treat their families,” he says. “Sometimes I would have meals with them. It didn’t make sense to send them back to someone else’s business.”
Helou began promoting the service locally, delivering flyers to letterboxes and nearby businesses after work. His wife managed bookings while he was working during the day and as demand grew, he realised the service could become a full-time venture.
But leaving a secure job to start a business was not an easy decision.
“I was shaking sending my resignation letter,” Helou says. “My wife was pregnant, we were renting, I had plans for another property, and I was leaving a well-paying job.”
With limited capital, he found a creative solution. A neurologist needed an audiologist to assist with vestibular cases and offered Helou clinic space and access to equipment. In return, Helou launched NeuroAudiology Australia initially in the ENT specialists’ rooms, which complemented his mobile wax removal business.
The arrangement allowed him to provide a broader range of services, including hearing assessments and vestibular diagnostics. Since then, NeuroAudiology Australia has grown rapidly and now operates five clinics and employs 10 staff.
Both of his businesses are listed on the Home Visit Network website, helping patients find mobile healthcare services.
A chance appointment also helped raise the profile of the mobile business. While performing cerumen removal on a child, he discovered the family had connections to popular Sydney talkback radio station 2GB.
The grateful parent offered him a segment which generated strong audience response. “The response was huge, so I was invited back for more sessions,” he says.
Helou has since appeared several times on 2GB discussing topics including hearing loss, prevention, tinnitus, vertigo, sudden hearing loss and ear wax management. Listeners call in with hearing concerns, creating opportunities to educate the public about hearing health.
Demand in aged care
A significant proportion of Helou’s patients come from aged care facilities, where cerumen impaction is particularly common. His research determined that about one-third of nursing home residents require ear wax removal and his mobile service now visits about 25 nursing homes regularly.
Many elderly people struggle to attend appointments due to mobility or health issues, making visits to their homes for cerumen removal valuable for them and his service.
Clients also include busy professionals who prefer the convenience of treatment at home, and individuals with disabilities who find travel difficult.
“A lot were previously waiting two or three months and didn’t know the service existed,” he says.
Providing cerumen removal in patients’ homes can present logistical challenges though. Helou says he uses VorOtek equipment with microsuction, which allows both hands to remain free during procedures.
“The way I’m doing it now is I need to have full control,” he says. “Sometimes I’m leaning over someone in bed, for example.”
His equipment is packed into one compact case so it can be transported easily between appointments in his car.
Although mobile environments can be unpredictable, careful positioning and experience help ensure safe procedures.
Helou first completed an online certificate in cerumen removal, initially practising on family members. He later undertook a course at Macquarie University to consolidate his skills.
“I trained myself on my large family,” he says. “Then I did the course to make sure I was doing everything as well as possible.”
Hands-on experience quickly followed through his growing mobile service.
Patient gratitude and word-of-mouth
Helou says patient satisfaction is one of the most rewarding aspects of cerumen removal, with many clients being surprised and delighted that the service can be delivered at home. The business has more than 600 positive Google reviews including 366 five-star reviews. Many new patients arrive through word-of-mouth referrals.
Both Chittleborough and Helou believe cerumen removal should be integrated into broader audiology care and encourage clinicians to view it as part of a complete hearing health pathway.
“It helps you provide a complete service,” Helou says. “You’re not sending patients between two or three different places when it can all be done in one.”
He also notes the importance of ensuring the ear canal is clear before fitting hearing aids.
“If you’re fitting a hearing aid, that’s important to do beforehand,” he says. “Even if it’s not completely blocked, removing wax can improve the function of the hearing aid.”
With an ageing population, increased hearing aid use and declining availability of ear syringing in general practice, demand for cerumen removal services appears set to grow. Both audiologists say the profession is well positioned to meet that need.
For Chittleborough, the key message is professional responsibility. “We’ve known for a long time about the usefulness of it for clinicians because we can’t really do our jobs without doing ear wax removal,” he says.
For Helou, the service also offers an opportunity to build meaningful connections with patients.
“It’s about being part of something bigger and implementing change in the industry,” he says. “Find your passion and make the profession work for you.”
As training options expand and technology continues to evolve, cerumen removal may increasingly become a defining element of modern audiology practice, helping clinicians deliver more comprehensive
care while keeping the pathway to hearing clear.
