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Independents' Day

Should we still be syringing ears?

QOur practice nurse says we should no longer syringe ears routinely.

Is this now national policy, and if so, what should

we do instead and why?

ASyringing as a means of wax removal can still be performed routinely if indicated.

There is no policy stating primary care providers should no longer syringe ears.

Syringing is perfectly safe if carried out by a fully-trained person in an appropriately selected patient. Initial use of ceruminolytics may be required.

Patients with known contraindications (tympanic membrane perforation, recent otitis externa or otitis media, previous middle ear/mastoid surgery, only hearing ear) should not be syringed and should be referred for dewaxing under direct vision.

Safe techniques have been well-described in many texts. Electronic irrigation devices, which deliver standard water pressure, are recommended.

If all patients with earwax were referred the ENT clinics would soon be overwhelmed and unable to offer the secondary ENT service they are intended to provide.

Protocols for direct-access audiology and hearing aid referral generally require the ears to be clear of wax.

If patients referred directly for hearing aid fitting are found to have occlusive earwax they may be sent back for wax removal, so delaying their fitting. Syringing is especially important in this group.

There is concern regarding perforating the ear drum while syringing.

A study posing the question 'Can ear irrigation cause rupture of the normal tympanic membrane?' concluded that in a normal tympanic membrane it was not possible to generate sufficient pressures with

water irrigation to cause a rupture.

Mr Sam Jayaraj, specialist

registrar, and Mr Theo Joseph, consultant ENT surgeon,

Royal National Throat,

Nose and Ear Hospital

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