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Practices should remove earwax causing hearing loss, NICE recommends

Practices should offer to remove earwax in adult patients if it contributes to hearing loss or other symptoms, according to a draft guidance released by NICE.

The guidance says GP surgeries or community clinics should look into providing this service because it would reduce the need to refer patients to a specialist ear, nose and throat (ENT) service.

It also advised against manually pumping water into the ear through a syringe, warning that the ’design of the syringe and the inability to control the water pressure increases the risk of damage to the ear canal and tympanic membrane’.

Instead, it recommends using an electric irrigator after the pre-treatment wax softeners, which it claims is less harmful. Other methods such as microsuction and manual removal are acceptable.

It also recommends GPs:

  • Refer adults with sudden or rapid onset of hearing loss that is not explained by external or middle ear causes.
  • Refer immediately adults with acquired unilateral hearing loss and altered sensation or facial droop on the same side to an ear, nose and throat service or, if stroke is suspected, follow a local stroke referral pathway.
  • Refer immediately adults with hearing loss who are immunocompromised and have otalgia (ear ache) with otorrhoea (discharge from the ear) that has not responded to treatment within 72 hours to an ear, nose and throat service.
  • Consider a suspected cancer pathway referral to an ear, nose and throat service for adults of southeast Asian family origin with hearing loss and a unilateral middle ear effusion not associated with an upper respiratory tract infection.
  • Consider referring people aged over 40 with unilateral hearing loss and otalgia that has lasted for more than three weeks to an ear, nose and throat service.

NICE director Professor Mark Baker said: ‘Our draft recommendations can help improve care for people with hearing loss through better management of earwax and referring people with symptoms to the right service at the right time.

‘We encourage those working in primary and specialist services, patients and stakeholders to comment on the proposed advice.’

The draft guidance is currently out for public consultation and will run until 12 January 2017.

Related images

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Readers' comments (21)

  • Sorry NICE. I can't seem to hear you any more.

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  • Cobblers

    Jeez that photo you are using. Is that a nurse looking in that lug 'ole? Can't be a doctor.

    She is pulling at the lobe of the ear not the upper part of the pinna (to straighten the ear canal) and the otoscope has no protection against movement of the head.

    Oh and ear wax should be sent for micro-suction to the hospital or wherever. Irrigation is time consuming, medico-legally fraught and we aren't paid for it.

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  • Information overload. Even ear wax needs guidance now. Next comes Royal college of ENT, physicians, RCGP, European ear wax society and patient's ear wax pressure groups, GMC protecting patients setting standards for ear wax? It gets more ridiculous.What's next? Urine?

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  • Maybe I am wrong, but I seem to remember the MDU advising us that ear wax syringing was medico legally indefensible

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  • needs to be community clinic. my staff are too busy

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  • NICE should not be recommending who delivers the service, only stating the best available clinical evidence for the effectiveness of the activity. They have significantly overstepped their remit.
    This is not core work. Of course it can be delivered in general practice, it is up to the commissioners to decide where to commission it for the best value. But too often what they would pay £150 for in the hospital they expect practices to do for free.

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  • Just Your Average Joe

    The 'Ivory Tower Experts' have done their cost analysis and it came out at the record lowest amount in their history.

    Foist the ear wax removal onto GPs never ending open contract and it will be done for free - forget the fact its not part of the core contract and there is no payment/resources/expenses/medico-legal cover for this.

    Commission a service for ear wax -and then the money saved from referrals to secondary care - would fund Crown indemnity for all GPs and NHS staff.

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  • Jones the Tie

    ScottishGP...your comment has made my day! Locally our CCG has for the past 18 months or so accepted that they need to 'commission a service' as GPs woke up and smelled the coffee and realized not GMS so sod off we're not doing more work for jack-shite anymore. However still no community clinic despite CCG telling us they have been 'doing a piece of work' . I'm really tempted to bring it up again at LMC tonight as is the only thing that keeps me giggling. My kids are even aware of the ear-wax saga FFS :o)

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  • Rogue1

    Yes if our nurses can be trained in ear suction. The going rate of £45/ear or £75/two who is going to pay? The patient wont like that especially as its free at the local hospital.

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  • Send all ear wax patients to the NICE clinic with a printout of their guidelines to show them and tell them it's done there.

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