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Aural Care

Ear Wax - Key Facts

Symptomatic ear wax is common with around 2.3 million primary care consultations a year. If earwax is contributing to hearing loss, other symptoms, or needs to be removed to examine the ear, NICE recommends removal (in adults) in primary care or community ear care services. Access to services is important as the condition is prevalent among older people and those with reduced cognitive function.

Effects

  • Commonly presents with discomfort and sensation of fullness or blockage.
  • Occasionally causes earache, tinnitus, itching or cough.
  • Prevents diagnosis of other conditions, including hearing loss.
  • Is a common cause of deafness and must be excluded or treated before referral to audiology?
  • Can cause safety and occupational issues, for example, for builders, drivers, railway workers, police.

Diagnosis

  • Can be confused with foreign material including cotton bud tips or wool.
  • Even a small quantity may cause symptoms if resting against the eardrum.
  • Wax may be of various colours or consistency.
  • Rarely painful.

Prevention

  • Items placed in ear can make the effect of wax worse, including cotton buds and hearing aids.
  • Wax commonly exacerbates hearing loss, especially in older adults. Good practice includes preventive checks for people with reduced cognitive function.
  • There is no good evidence preventive ear drops work.

Treatments

These include electronic irrigation, microsuction, mechanical removal with specially designed instruments, and self-irrigation. Relief of symptoms is almost immediate and appreciated by patients.

The practitioner must have training and expertise in using the method to remove earwax and be aware of its contraindications.

Never use metal or plastic syringes as they can be dangerous.

Some localities have purposive ear wax clinics which may be useful for more difficult cases. NICE advises that referral to secondary care is not an appropriate use of resources.

Irrigation with an electric irrigator is effective and can be carried out in the practice by a trained member of staff.

It should be recorded in the patient notes as ‘irrigation’ not ‘syringing’ as the latter refers to the obsolete method:

  • two attempts may be needed
  • drops may be instilled 15 minutes before irrigation, this can save patient appointments and clinician time
  • poor evidence of any difference between drops (olive oil or sodium bicarbonate) other than side effects, so water can be used there is little evidence for courses of drops longer than 3-5 days help

Microsuction and mechanical removal (for example, with a Jobson-Horne probe) can be used where irrigation fails but are resource-intensive requiring skilled staff and equipment.

Self-irrigation with bulb syringes can be effective, reduce the demand for treatment (Coppin, 2011), and is commonly used in Europe and the US. An NHS treatment pathway from City and Hackney CCG is available online.

Reference

Coppin R, Wicke D, Little P. Randomized trial of bulb syringes for earwax: impact on health service utilization. Annals of Family Medicine. 2011; 9(2):110-4

Patient Support

RNID has produced advice on what to do if wax builds up.

References

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