Earwax removal
Earwax removal
Given the sparsity of GP practice-based earwax removal, other providers have emerged in primary care. Most offer the service privately. Ear syringing is no longer recommended.
NICE advises considering ear irrigation using an electronic irrigator, microsuction or another method of earwax removal (such as using a probe) for adults only if the practitioner has training and expertise in using the method to remove earwax, is aware of any contraindications to the method, and the correct equipment is available.
ENT UK (the professional body representing ear, nose and throat specialists) recommends that clinicians have a designated pathway to obtain clinical advice in case complications arise. This is something that local service commissioners will take into consideration.
Many private earwax removal providers in the UK now use microsuction. A small probe (like a mini vacuum cleaner) is inserted into the ear canal and low pressure suction is used with no need for water.
When carrying out earwax removal pre-treatment wax softeners should be used, usually for three to five days initially. NICE also advises that wax softeners can be used immediately before ear irrigation, although this is not common practice. For ear irrigation, NICE advises:
- If irrigation is unsuccessful: repeat use of wax softeners or instil water into the ear canal 15 minutes before repeating irrigation
- If irrigation is unsuccessful after the second attempt, refer the person to a specialist ear care/ENT service for removal of the earwax.
Following the procedure, the ear should be examined with an otoscope (or microscope) to check that the wax has been fully removed and that the eardrum is unharmed. Clinicians should also look for old, healed perforations and inspect the canal for otitis externa.
There are rarely complications arising from irrigation or microsuction but if severe pain, deafness or vertigo occurs during or after irrigation, or if an acute perforation is seen following the procedure, immediate medical advice should be sought.
Increasingly, community pharmacies are providing private earwax removal services. Some pharmacies now offer microsuction with typical fees of between £40-£60. The NPA has partnered with TympaHealth to offer private ear and hearing health checks including microsuction for earwax removal and hearing assessments.
The idea is to improve community access to ear and hearing healthcare, enhance the patient experience and unlock a new private clinical income stream.
Learnings from a hearing health pilot study in pharmacy
A recent NHS pilot in community pharmacies in South West London involving TympaHealth was set up because of “a lack of equitable and free NHS earwax removal and hearing health check services in the area”. The rationale was that “patients may often be referred (by their GP) on to an ear, nose and throat (ENT) consultant or audiologist within secondary care and consequently face long waiting times or may be directed to seek private treatment elsewhere at their own cost or may choose to seek private treatment to avoid waiting”.
The 12-month pilot, with funding from the NHS elective recovery programme, used the Tympa device (an otoscope combined with microsuction function and hearing assessment facility) alongside the TympaHealth support service, which included training, and access to clinical advice and a second opinion using images uploaded from the devices. The use of the support service actually declined once pharmacists grew more familiar with assessing patients’ ear health needs.
To access the service patients required referral from their GP, with 7,648 patients treated by 20 pharmacy teams over the 12-month period of the pilot. The project appeared successful with 85 per cent of patients undergoing microsuction earwax removal in the pharmacies, most treated within four weeks. However, the project finished in April 2024 as no more funding was available.
Reflection exercise
- What options do you have locally to refer a patient with hearing loss and impacted wax for treatment?
- Do any of your local GP practices provide earwax removal on the NHS?
- Are there any other NHS earwax removal services near you?
- If you need to refer a patient, would this be to a GP practice?
- Do you currently offer a private service or can you refer patients to another provider?