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Removing earwax is down to GP practices, says new NICE guideline

GP practices should provide earwax removal services rather than referring patients to specialists, according to the latest NICE recommendations.

The adult hearing loss guidelines, released today, said that if earwax is contributing to hearing loss or needs to be removed for an ear examination, practices or community clinics should provide the service rather than referring them to an ears, nose and throat specialist for the same procedure.

But the BMA's GP Committee said this guidance 'places no obligations on GPs to provide this service unless contracted to do so', and suggested CCGs needed to commission the service separately.

The new NICE hearing loss guidance also recommends that GPs:

  • Advise adults not to remove earwax or clean their ears by inserting small objects, such as cotton buds, into the ear canal, as this could cause damage or push the wax further into the ear;
  • Refer adults with sudden onset or rapid worsening of hearing loss in one or both ears, which is not explained by external or middle ear causes;
  • Immediately refer 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;
  • Immediately refer 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 making an urgent referral to an ear, nose and throat service for adults of Chinese or south-east Asian family origin who have hearing loss and a middle ear effusion not associated with an upper respiratory tract infection;
  • Consider referring adults with hearing loss that is not explained by acute external or middle ear causes to an ear, nose and throat, audiovestibular medicine or specialist audiology service for diagnostic investigation, using a local pathway.

NICE has estimated that 2.3 million people in the UK each year have problems with earwax sufficient to need intervention.

A spokesperson said: ‘The NICE guideline aims to help improve care for people with hearing loss through better management of earwax, prompt and accurate referral of people with symptoms to the right service at the right time, and robust assessment and correct treatment.

‘It recommends that GP surgeries or community clinics should offer to remove earwax if a build-up is contributing to someone’s hearing loss. This means patients do not need to be referred to a specialist ear, nose and throat (ENT) service for the same procedure.’

They added that if a patient experiences sudden hearing loss without an obvious cause, they should be referred immediately to a specialist service or an emergency department.

However GPC clinical and prescribing policy lead Dr Andrew Green responded: 'NICE is responsible for clinical guidance but have nothing to do with commissioning services which are the responsibility of CCGs.

'The fact that NICE recommends something as suitable for primary care places no obligations on GPs to provide this service unless contracted to do so.'

Readers' comments (28)

  • NICE states- Consider ear irrigation using an electronic irrigator, microsuction or another method of earwax removal (such as manual removal using a probe) for adults in primary or community ear care services if:

    the practitioner (such as a community nurse or audiologist):

    has training and expertise in using the method to remove earwax

    is aware of any contraindications to the method

    the correct equipment is available

    so "consider"..."community ear services"... This is not core GMS and if not commissioned then that is CCG's issue

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  • GP federations could sort this for 30-50,000 patients but privately. £20 one ear, £30 for two.

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  • GP who don't offer syringing would appreciate it when their ears are blocked and olive oil did nothing after 2 weeks instillation. when patient can hear after syringing, see the delight on their faces.

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  • Such a shame we don't have the "correct equipment available" anymore...

    Semiretired - I'm hoping to get to semiretired also and wont get there if keep doing more unfunded work. As a GP I wouldn't want my ears syringed for free, I'd expect and be willing to pay for microsuction.

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  • But we’re not permitted to charge right ?

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  • I don't disagree with previous writers but I do syringe some patient's ears sometimes. People do get distressed by their deafness, instant results and very grateful patients. And despite the dangers of the orocess ou may have heard, no one has come to harm using modern syringing machine. !

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  • Tim....GMC ....and CQC ....wants to know more about...your inclusion/exclusion criteria re some patients ears sometimes....?!

    Simples not contracted...not done !

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  • Another great laugh from the National Institute of Clinical Excrement.

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