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Ear wax removal should be offered by GP and community clinics, NICE says

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Patients should be offered the chance to have earwax removed at a GP surgery or community clinic rather than being referred to a specialist, the National Institute for Health and Care Excellence has said.

The new policy is laid out in the latest NICE guidance, Hearing Loss in Adults: Assessment and Management.

Ear wax should be removed when the build-up is contributing to hearing loss, causing other symptoms, or making it hard to examine the ear or take an impression of the ear canal, the guidance states.

It says that earwax removal can be done by a community nurse or audiologist as long as they have the training and expertise to do it, are aware of any contraindications to the method, and have access to the correct equipment.

The guidance states that healthcare staff should not use manual syringing for adults with earwax.

Instead they should consider offering ear irrigation using an electronic irrigator, microsuction, or another method of earwax removal, such as manual removal using a probe.

Staff should also warn patients not to clean their ears with cotton buds as this could damage the ear canal and ear drum, and push the wax further into the ear, NICE states.

About 2.3 million people each year have problems with earwax sufficient to require intervention, especially older people and those using hearing aids or earbud-type headphones.

Primary care professionals are advised to use pre-treatment wax softeners, either immediately before ear irrigation or for up to five days beforehand. If irrigation is unsuccessful they should repeat the use of wax softeners or instil water into the ear canal 15 minutes before repeating ear irrigation.

If the second attempt is unsuccessful, the patient should be referred to a specialist ear care service or an ear, nose and throat service for removal of earwax.

NICE set out other circumstances when a patient should be referred to a specialist after initial treatment at a community clinic or GP surgery has been tried. These include: partial or complete obstruction of the external auditory canal that prevents a full examination or the taking of an aural impression; pain lasting for one week or more; a history of discharge (other than wax); abnormal appearance of the outer ear or eardrum; and a middle ear effusion without (or persisting after) an acute upper respiratory tract infection.

The guideline also covers when people having hearing difficulties not caused by earwax or an infection should be referred to an audiologist. Other recommendations explain when hearing aids should be offered to adults, such as when hearing loss affects a person’s ability to communicate and hear.

Hearing loss is a major public health issue affecting about nine million people in England, NICE says. Due to an ageing population it expects the number to rise to around 13 million by 2035. 

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Readers' comments (1)

  • Local policy in Harrogate is to instil olive oil for 2 weeks before irrigation is performed. This approach is to encourage self care and remove the need for intervention from a HCP, as the wax problem may resolve. This causes much debate between Drs, nurses, HCA’s and patients. I have no idea where this guidance has come from, coming from out of area, and would love to hear from anyone who can evidence this approach. Also, there is no reimbursement for this service, which is another reason for GP practice’s to remove this service.

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