Troublesome Ear Wax
Ear wax is a normal physiological substance with several benefits including water repellence, moisturising the ear canal skin, presenting a sticky barrier to dirt and debris proceeding deeper into the ear canal. Ear wax also has bactericidal and fungicidal properties.
In the vast majority of cases, ear wax will not cause any problems and should be left alone without any attempts to remove it.
NHS Kernow has a 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.
Patients with routine ear wax should initially be recommended the following:
- Olive oil spray (such as Earol) 2 sprays in affected ear(s) 2 times a day for 4 weeks
- OR olive oil drops, 3 drops in affected ear(s) 2 times a day for 4 weeks
If the wax persists, and not contraindicated:
Sodium bicarbonate drops, 3 drops in affected ear(s), 3 times a day for 2 weeks
Contraindications to sodium bicarbonate drops:
- Known tympanic membrane perforation
- Active infection, eczema/dermatitis of ear canal and/or external ear
- Contraindications to sodium bicarbonate drops:
- Sodium bicarbonate drops, 3 drops in affected ear(s), 3 times a day for 2 weeks
Recommendations for all patients with persistent ear wax:
- 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, earwax can be removed using irrigation or microsuction. Routine wax does not need to be removed. Patients may wish to consider consulting a private ear wax removal service provider if this is important to them.
Troublesome ear wax that has not responded to ear wax softeners should be managed by irrigation if this is available in primary care. If irrigation is not available, patients may wish to consider consulting a private ear wax removal service provider.
When to Refer
NHS Kernow does commission an Aural Care Service. Microsuction can be performed by the team at RCHT but ONLY if ear wax is troublesome AND ear wax softeners have failed AND irrigation is contraindicated, as follows:
- Known tympanic membrane perforation
- Healed tympanic membrane perforation where a specialist has documented advice to avoid irrigation (this would apply if the tympanic membrane is very thin and at risk of perforation from irrigation)
Past history of middle ear surgery (stapedotomy, myringoplasty and mastoid surgery)
- Wax that has not responded to wax softeners with a history of grommets that have been extruded for 18 months or more are appropriate to attempt irrigation
- There are clearly documented complications following previous ear irrigation including perforation of the eardrum, severe pain, deafness, or vertigo/tinnitus. Please note microsuction also carries these risks.
- Active infection, eczema, dermatitis of the ear canal or external ear
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.
If subsequently it becomes apparent that the referral does not fit with the access criteria, microsuction will not be performed and the patient will be returned to the referrer.
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.
Minimal Referral Information:
- Patient symptoms and examination findings
- Confirmation that the full course of recommended drops have been completed
- Confirmation of contraindications to irrigation