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Ear wax and microsuction

Checked: 23-02-2018 by Rob Adams Next Review: 23-02-2020

Management in Primary Care

Clinical Knowledge Summaries has advice on management of ear wax and irrigation in primary care.

Our ENT GPSI advice is as follows:

In primary care regular drops can be used, either oil based (CKS recommends olive or almond oil if not allergic) or sodium bicarbonate. Obviously it is important to advise against the use of cotton buds. Syringing can be tried as long as there are no contraindications, after using drops for a few days. There's a detailed list of contraindications in CKS but they are mainly intuitive such as TM perforation, previous ear surgery or recurrent infections.

Alternatives to nurse led syringing

Self care -There are some self-care guidelines for management of ear wax on the NHS choices website.

A locally produced leaflet is also available here Blocked Ears (Wax) - A self-care guide for patients and on the ICB website so the link can be sent to patients here: Blocked ears leaflet - NHS BNSSG ICB

Bulb syringes - Some GP surgeries no longer offer ear syringing. If initial self-care is ineffective then some CCGs and GP practices are now advocating use of Bulb Syringes (if no contraindications such as perforation, pain or discharge), although there is still some controversy over their use. If patients have ear wax confirmed on examination, do not have contraindications and are willing to try this method then this may be an option. Bulb syringes can be bought from local pharmacies.

Ear candles - are not recommended and their use should be discouraged due to risk of injury.

Private ear syringing/microsuction - this is now becoming more widely available from some high street opticians and pharmacies.

Referral for microsuction

The supplementary services specification contract for 2019/2020 includes the offering of irrigation in GP practices. Irrigation should now be offered first and foremost in the primary care setting for those patient’s where it is clinically appropriate. If you have any questions regarding this please contact bnssg.pc.contracts@nhs.net

Referral for microsuction of ear for wax or for any other indication is subject to a restricted access policy:

Microsuction for Ear Wax, Discharge or Debris Removal in Secondary Care - CBA / PA Policy

This policy allows onward referral without prior approval if certain criteria are met e.g. previous cholesteatoma surgery or recurrent or chronic ear canal pathologies (see policy for details). For other indications prior approval is required.

Referrals that meet criteria or have prior approval attached can be referred via eRS (ENT - ear - request nurse led aural toilet clinic). Clinics are available at St Michaels Hospital and EGTC.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.