Borders Ref Help Toolkit
Refer patients via SCI Gateway to ENT who need ear wax removal when ear irrigation has not been effective or is contraindicated. These patients will be seen in a nurse led microsuction clinic
Ear wax
Ear wax is produced by the skin of the ear canal. There is a natural conveyor belt of wax, skin and debris that removes the wax over a period of weeks. Problematic wax accumulation can be seen when either
- The natural migration of wax is disrupted e.g. from cotton buds, ear plugs or pods or itchy ears or
- The migratory process does not work well e.g. elderly, previous radiotherapy or surgery.
Ear wax only needs treatment if
- It is causing symptoms such as hearing loss or pain
- It is obscuring a diagnostic view of the tympanic membrane
- Prior to a hearing test
- Issues related to hearing aid use or fitting.
Advice against sticking anything in ears such as cotton buds, ear pods etc
Treat any itching with a topical steroid to reduce the risk of recurrent ear wax. e.g. synalar gel 0.025% applied to ear at night for 5 days
Sodium bicarbonate ears drops 4+ drops at night in the affected ear for 4 weeks. Advise patient to lie on their side with ear to be treated facing upwards. Drops are ideally applied by someone other than the patient and they should apply intermittent tragal pressure for 5-10 seconds after the drops are applied. They should lie in that position for 5 minutes.
If the drops fail to clear the wax then consider ear irrigation unless contra-indicated due to
- Active infection
- Known/suspected current perforation or grommet
- Previous mastoid or middle ear surgery unless documentation from an ENT surgeon that irrigation is safe on a specific patient
- Previous negative experience with ear irrigation