No, it doesn't mean he will need to do an irrigation. The whole idea of using the Debrox is to have that medication do the removing. The drops produce a foam on contact with the air to soften and dissolve the ear wax so it will come out of your ear canal on it's own. When you use the drops, don't be surprised if you hear a lot of popping noise, almost like listening to a bowl of Rice Crispies in milk. You may also notice small brownish spots show up on your pillow case, since it's most likely to drain out of the ear while you toss and turn in your sleep. If it is necessary, when you return to the doctor, he may need to do an irrigation to remove any wax that is still present, but it will be much softer and easier to do. Ear irrigation should not hurt, unless the ear canal is already irritated or the person doing it is using too much pressure behind the syringe. If you need to have it done and it hurts, by all means stop the procedure and say so. They should only be using warm water, and possibly adding a bit of hydrogen peroxide, and before that they should be putting in a bit of the Debrox. There is no need to be frightened of the procedure, as I said, it should not ever hurt. It may be uncomfortable if the canal is irritated, but not painful. It should also be done with warm water, and very gently. At the most, some folks get a bit quesy from the sound of the water- but it usually passes if you stop and wait a few moments before going on. Just use the Debrox as directed, and it should do the job for you just fine.