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Last updated: 30 March, 2020 15:59pm

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Ear Wax – Information for GPs

Management

Recommend patients avoid putting objects in the ears to try to manually remove wax. This can impact the wax by pushing it further down the ear canal.

Self-treatment should be with olive oil or sodium bicarbonate ear drops used twice daily for 2 weeks with the following advice:

How to use ear drops

(having someone else administer the ear drops may make it easier)

  1. Wash your hands
  2. Warm the drops to body temperature by holding the container in your hands
  3. Tilt the affected ear up or lie on your side
  4. Pull the ear upward and backwards
  5. Put the drops in your ear
  6. Gently massage the small skin flap (tragus) over the ear to help the drops reach the ear canal
  7. Keep the ear in this position for a few minutes

Syringing

Should usually be attempted in general practice before referral for microsuction, unless there are contraindications such as:

  • Have had complications following this procedure in the past
  • Have had ear surgery in the past (apart from grommets that have come out at least 18 months previously and you have been discharged from the hospital ear department)
  • Have a cleft palate (even if it has been repaired)
  • Have an ear infection or have had an ear infection in the previous six weeks
  • Have recurring infections of the ear canal (recurring otitis externa)
  • Have, or have had, a perforated eardrum

* July 2019, update
The CCG does not commission ear syringing in line with many other CCGs around the country. It is up to individual GP Practices to decide if they want to provide this service. There are some GP practices in the NHS Scarborough and Ryedale CCG area who do still provide the service and others who do not. Patients who require wax removal  for specific ear conditions continue to have this performed in a hospital setting - and this will not change. Patients who do suffer from a build up of wax, should regularly apply drops to prevent such a build up.   However it is important that you speak to your Practice Nurse about taking this course of action as there are some circumstances where it may not be appropriate.

Clearing ear wax under direct vision

With a Jobson Horne probe is an option if you are suitably trained and ensure that you can always see the end of your probe to avoid causing damage to the tympanic membrane. Referral will be necessary in cases where the above does not work.

Patient information leaflets

Information to include in the referral letter

  • What has been tried so far and the effect the wax impaction is having on the patient
  • Relevant past medical/surgical history
  • Current regular medication

References

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