Ear-Wax removal on the national agenda

Ear wax is wonderful, but you can have too much of a good thing.

 

Cerumen (or ‘ear wax’ to be less formal) is an antimicrobial, antiseptic, lubricating and protective marvel; but it can be a real “pain in the ears” too. It’s also one of the most common and easily treated causes of hearing loss (and even tinnitus).

Sometimes there’s nothing that you can do to stop ears getting blocked up, but there are a few things that can increase your chances of ear wax becoming troublesome. Some of them you can’t do anything about (advancing age, hearing aid use for example). Some of them you can (stop poking around inside your ears with cotton buds/hair clips/pen lids!)

For us at Click Hearing, there is no doubt that microsuction ear wax removal is a large, and ever growing, part of our clinical service. Until the regulatory duties of the Hearing Aid Council were replaced by the HCPC in 2010, private audiologists and hearing aid dispensers were prohibited from offering any wax removal services and we would direct clients to their GP practice for removal. I always thought that this was a little strange given that an audiologist should have a better idea about ear canals and ear drums than most. Naturally, appropriate training and equipment is vital, but fast forward 8 years and I’m not sure what we filled our diary with prior to 2010!

When clients attend for microsuction, one of the questions that I always ask is “who recommended that you come to us for treatment”. There are a significant number that come to see us because they have previously had a bad experience of irrigation with water (ear syringing), or because they prefer not to wait for an appointment with their GP or practice nurse. Interestingly though, there is a growing number of responses that indicate that their GP practice recommended us; that their GP surgery doesn’t remove ear wax anymore; and even that A&E gave our details to them.

The impression I get is that more and more GP practices are not carrying out ear-wax removal anymore; preferring instead to recommend ear drops and wax softeners. This is great advice in many cases. There isn’t any evidence that one ear-wax softener is better than another, but olive oil is the first choice in most cases (and the one that I tend to favour).
There can be a problem when drops don’t solve the problem though. Even a tiny gap in the ear-wax will allow sound to be heard pretty effectively. Adding oil or ear drops to a ‘nearly’ blocked ear canal does a great job of sealing up any of those tiny gaps meaning that you feel 10 times deafer than before you started the treatment. The wax might be nice and soft by then- perfect for syringing; but only if your surgery offers it and if they don’t, then it’ll be off to the hospital for microsuction. If you’re lucky maybe you’ll manage to get an NHS appointment with the Ear Nose & Throat department in 2 weeks; if you’re not, maybe it’s 12 weeks.

Believe me, trying to get through a day or 2 with both ears completely blocked is horribly frustrating.
So why is it becoming so difficult to have ears cleaned at your local surgery or community clinic? I haven’t been able to find anything conclusive but some feel that the risk of litigation is too high and one source suggests that complications from ear wax removal account for up to 19% of claims against GP surgeries. Other people have suggested that GP’s aren’t funded for ear wax removal and so would not be inclined to take the time (and the risk suggested above) to carry out the procedure.

Hopefully that’s set the scene for a couple of interesting documents that I came across recently.
The National Institute for Clinical Excellence has a draft document out (due for publication in May 2018) addressing the removal of ear wax. You can view it here, but the headlines are:

• Ear wax should be removed if it is contributing to a hearing loss
• It should be done in primary care and not referred to specialist ENT services at the hospital
• Using drops to soften ear wax for up to 5 days is advisable

I also came across this document from Barking & Dagenham, Havering & Redbridge CCG (the teams that manage spending for their local NHS services). Click here to see the document and on page 20 you’ll see that they are also considering stopping referrals for microsuction wax removal except in cases where irrigation is not appropriate (such as previous ear surgery, perforated ear drums, ear infections etc). They also estimated that there were over 2700 ear wax procedures carried out in the year, costing over £400,000. For interest, we carried out over 1400 procedures last year and charge a maximum of £65 for the procedure.

In summary:
• Ear wax should be removed if it’s contributing to hearing problems.
• Many people are finding it difficult to have troublesome wax removed by their practice.
• Recommendations in May are likely to suggest that wax removal should not be referred to the hospital.

Quite a sticky situation ahead!

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