NHS Tayside RefGuide
NICE Guidelines have stated irrigation is safe
Consider removal
- If earwax is totally occluding the ear canal and any of the following are present: (hearing loss, earache, tinnitus, vertigo)
- If the tympanic membrane is obscured by wax but needs to be viewed to establish a diagnosis.
- If the person wears a hearing aid, wax is present and an impression needs to be taken of the ear canal for a mould, or if wax is causing the hearing aid to whistle.
Irrigation removal in primary care
- Patients to use ear drops for 3–5 days initially, to soften wax and aid removal.
- Olive oil, almond oil or sodium bicarbonate drops can be used twice daily for 3-5 days, it may take 2-3 courses of sodium bicarbonate.
- Do not prescribe drops if you suspect the person has a perforated tympanic membrane.
- If symptoms persist, consider ear irrigation, providing that there are no contraindications.
Ear irrigation may be possible in some practices: this is a well-established and generally safe procedure. There is a small risk of it leading to otitis externa and very rarely (1:1000 or less) of TM perforation.
Do not use ear irrigation to remove wax for people with:
- Grommets in place.
- Hearing in only one ear if it is the ear to be treated.
- A history of any ear surgery (except extruded grommets within the last 18 months, with subsequent discharge from an Ear Nose and Throat department).
- A mucus discharge from the ear within the past 12 months.
- A history of a middle ear infection in the previous 6 weeks.
- Cleft palate, whether repaired or not.
- Presence of a foreign body in the ear.
Angus has open access to ear microsuction.