Every year, more than 2 million people in the UK have troublesome ear wax that needs to be removed. However, more and more people are finding that this service is no longer provided at their primary care practice. Indeed, 66% of people applying for these services were told that earwax removal is no longer available on the NHS.
Questions have been raised in Parliament as to why people are being referred to earwax clinics in hospitals. This results in long waiting times and is not the best use of specialist services.
Many people resort to using private services on the high street which cost £50 to £100. But the Royal National Institute for Deaf People (RNID), a charity, reports that more than a quarter of people questioned do not can afford to pay to have earwax removed privately. This is especially true for people who require recurring earwax removal, such as those who wear hearing aids and earphones, which tend to cause impaction of earwax.
Our body produces earwax to clean, protect and keep our ears healthy. The movement of the jaw, as well as the skin lining the ear canal, causes the earwax to move towards the entrance of the ear where it then flakes off or is washed away when we wash. Sometimes this doesn’t work and the earwax gets affected. Impacted earwax blocking the ear canal is a major reason for GP consultations.
The National Institute for Health and Care Excellence (Nice) is clear that NHS earwax removal services should be provided in the community where demand is greatest. Why does this recommendation for community earwax removal services fall on deaf ears?
A recommendation from Nice is not a mandate and general practitioners are under no obligation to offer an earwax removal service. There are several reasons why this service is often no longer offered in primary care, some of which are based on misunderstandings.
First, hand-held syringes filled with water to get rid of earwax can cause high water pressure and damage a patient’s ears, which a primary care physician doesn’t want to be responsible for. (Alternative low-pressure water sprinkler devices are now widely available.)
Second, there is a misconception among some primary care physicians that earwax can be self-managed by using ear drops that soften earwax on their own. However, there is no good quality evidence that softened ear wax magically dissolves and disappears into the ether.
Effects of impacted earwax
The most common symptom caused by impacted earwax is difficulty hearing. This is often accompanied by discomfort and ringing in the ears. Healthwatch Oxfordshire, a charity, revealed that adults with earwax required one to four NHS visits before attending a dewaxing clinic, and that the time from the first appearance of symptoms to final resolution was three to 30 weeks.
Try simulating the effect of impacted wax by walking around with your fingers plugging both ears tightly for a few days. You will soon realize that what seems trivial at first glance is no laughing matter.
Hearing impairment means you can’t communicate easily or listen to TV. It also reduces your ability to detect and monitor sounds in the environment, such as an approaching car. Hearing difficulty can lead to social isolation and depression. More than nine out of ten people report that the affected earwax was at least moderately bothersome to them, and 60% said it was very or extremely bothersome.
Nice recommends removing impacted earwax by irrigating the ear with the latest and safest low-pressure water irrigation devices or microsuction to suck it out. When asked, most people have no preference, although some report that the water flush is messy and others that the microsuction causes discomfort and is noisy.
Earwax removal in healthcare centers using microsuction results in patient satisfaction levels at least equal to those provided in a hospital.
Before removal, pre-treatment drops or sprays are used to soften the earwax. These are applied daily for up to five days before removal. There are a variety of products to soften earwax before treatment, but none is better than another. As a result, most people use olive oil, which can be administered in the form of drops or sprays.
There are a variety of self-administered earwax management products on the market, but evidence for these is limited and none are currently recommended by Nice. One example is the use of Hopi candles or ear tapers. To use them, lay your head on one side and place the lit candle in your ear facing up.
These are said to work by softening earwax and then sucking it out of the ear canal and up the cone like a chimney. There is no evidence to support this claim. These candles and tapers cost money and are ineffective.
How could it be done
If individual general practice practices lack the experience or funds to provide earwax removal services, an alternative is for practice groups to work together as a network. The portable nature of modern wax removal equipment is ideal in such settings and for use in home visits. This approach could be especially valuable for vulnerable people, such as those in care homes where as many as 44% of residents with dementia have earwax impacted.
Meanwhile, the NHS withdrawal of earwax removal services is having a far-reaching impact, with people experiencing uncomfortable and painful symptoms, sometimes leading to poor mental health.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Kevin Munro does not work for, consult with, own shares in, or receive funding from any company or organization that would benefit from this article and has disclosed no relevant affiliations beyond their academic appointment.