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Troublesome Ear Wax

 

Background

Ear wax may be wet or dry and is a normal physiological substance that protects the ear canal. It has several functions; it cleans, lubricates, and protects the lining of the ear canal, trapping dirt and repelling water. It also provides a sticky barrier to dirt and debris, stopping them from proceeding deeper into the ear canal.

In the vast majority of people, persistent use of ear wax softeners will be sufficient enough to resolve any issues they experience with ear wax. Full details on the use of ear wax softeners can be found below, in this patient information leaflet

Although wax can obscure the view of the tympanic membrane, it does not cause permanent hearing impairment.

 

Please note

NHS Kernow has a strict commissioning policy for ear wax. If access criteria are not met, referrals for removal of wax will be returned.

The lack of access to a service to remove routine ear wax in primary care is not an acceptable reason for referral to the Aural Care Service at RCHT.  All such referrals will be returned. 

 


Routine Ear
Wax

Patients with routine ear wax should initially be recommended the following:

  • Olive oil spray (such as Earol) 2 sprays BD in affected ear(s) for 3 weeks
  • OR olive oil drops, 3 drops BD in affected ear(s) for 3 weeks

 

If the wax persists, and not contraindicated:

  • Sodium bicarbonate drops, 3 to 4 drops BD in affected ear(s) for 1 week
  • Contraindications to sodium bicarbonate drops include:
    • Known tympanic membrane perforation
    • Active infection, eczema/dermatitis of ear canal and/or external ear
  • Alternatively, continue olive oil treatment for further 1 week if sodium bicarbonate is contraindicated.

 

Recommendations for all patients with persistent ear wax:

  • Provide patient with PIL
  • Keep ears dry:
    • Use precautions to prevent water ingress when swimming, bathing, showering, etc.
    • Note that detergents in soap, shampoos, and conditioners can irritate the ear skin and increase the amount of wax produced.
    • This can be achieved using silicone swim plugs (available from pharmacies); a ball of cotton wool soaked in Vaseline or blu tac, positioned in the outer bowl of the ear (and not pushed into the canal)
  • Do not use cotton buds or any other implement to try and take the wax out. This causes the wax to be pushed deeper down the ear canal, often against the ear drum, and can cause trauma to the ear.

 

Troublesome / Symptomatic Ear Wax

When clinically indicated, troublesome ear wax can be removed using irrigation or micro-suction.Routine wax does not need to be removed.

Troublesome ear wax that has not responded to ear wax softeners should be managed by irrigation if this is available in primary care, unless it is contraindicated.

Patients may wish to consider consulting a private ear wax removal service provider if irrigation is not available OR they don’t meet the criteria for referral to the Aural Care Service OR they have routine wax and it is important to them to have it removed.

 

When to Refer

Removal of ear wax in secondary care via micro-suction is only commissioned in certain circumstances – you will need to provide documented evidence that the patient meets the criteria outlined below:

 

Ear wax remains troublesome following use of the ear wax softener standardised regime AND one or more of the following criteria are met:

  • There is a clearly documented active ear infection

OR

  • Active ear disease including eczema or dermatitis of the ear canal or external ear

OR

  • A known tympanic perforation

OR

  • There is a past history ear surgery, for example Stapedotomy, Myringoplasty or Mastoid surgery

OR

  • There is a healed tympanic membrane perforation where an Aural Care or ENT specialist has documented the advice to avoid treatment outside of secondary care – for example, the tympanic membrane is very thin and at risk of perforation from irrigation

 

 

Where these criteria are met, please refer to the Aural Care Service at RCHT.

 

If subsequently it becomes apparent that the referral does not fit with the access criteria, micro-suction will not be performed and the patient will be returned to the referrer.

Patients with severe anxiety, cognitive impairments, and learning disabilities must be offered reasonable adjustments to provide equity of service (as they are in secondary care) before referral to Aural Care Service is made. 


 

Minimum information to include referral letter

Please include all relevant clinical details within the referral letter, including:

  • Patient symptoms and examination findings
  • Confirmation that the full course of recommended drops have been completed
  • Confirmation of contraindications to irrigation

 

 

Individual funding request

If the referral criteria are not met and you think the patient has exceptional/unique clinical need then you may wish to consider an individual funding request

 


Review date
                         March 2022

Next review date                   March 2023

GP Sifter                               Dr Laura Vines

Contributors                          Jenefer Feenan (Aural Care Nurse Specialist)

                                             Tracey Coles (CCG)