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.
There are some self-care guidelines for management of ear wax on the NHS choices website.
Some GPs no longer offering ear syringing on the NHS. If initial self-care is ineffective then some CCGs are now advocating use of Bulb Syringes (if no contraindications such as perforation, pain or discharge) but there is still some debate over their use. If patients are willing to try this method then Wiltshire CCG provides an advice leaflet .Ear candles are not recommended and their use should be discouraged due to risk of injury.
Referral for microsuction
Referral for microsuction of ear for wax or for any other indication is subject to a restricted access 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.
For surgeries that are no longer offering ear syringing, prior approval can still be applied for as long as other criteria are detailed in the application.
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.