HNY Policy and Pathway Repository - Humber

A small amount of wax is normally found in the EAM.

Excessive wax should be removed before it becomes impacted, which can give rise to tinnitus, hearing loss, vertigo, pain and discharge.  

Irrigation should never cause pain.

If the patient has:

• previously experienced complications following this procedure in the past
• a history of a middle ear infection in the last six weeks
• undergone ANY form of ear surgery (apart from grommets that have extruded at least 18 months previously and it is documented subsequently that the tympanic membrane is intact)
• a perforation
• a history of a mucous discharge
• a cleft palate (repaired or not)
• If there is evidence of acute otitis externa with pain and tenderness of the pinna

Guidance On Management

It was previously the expectation of NHS England that ear syringing was provided by all GP practices as part of core services. As CCG's now have responsibility for Primary Care commissioning this will remain the case where clinically appropriate.

Removal of Excessive Wax

Extended use of olive oil may be preferable to wax removal procedures.

Ear Irrigation Using Electronic Irrigator

• Correctly treat otitis externa where the meatus is obscured by debris
• Improve conduction of sound to the tympanic membrane when it is blocked by wax
• Remove  discharge,  keratin  or  debris  to  allow  examination  of  the  EAM  and  the  tympanic membrane
• Remove wax in order to facilitate hearing aid mould impressions
• Facilitate the removal of wax and foreign bodies, which are not hygroscopic, from the EAM
• Hygroscopic  matter  (such  as  peas  and  lentils)  will  absorb  the  water  and  expand,  making removal more difficult

Precautions (Ear irrigation should be carried out on a low setting)

• Tinnitus
• Healed Perforation
• Dizziness
• Patient taking anti-coagulants

Children

Irrigation can be carried out on children as long as the child has no contraindications.

Potential complications following procedure

• Trauma
• Infection
• Dizziness
• Tinnitus

Microsuction

Use of the microscope and suction is carried out to remove:

• cerumen and hygroscopic foreign bodies in patients who are not appropriate for ear irrigation
• discharge, keratin or debris from the external auditory meatus or mastoid cavity

Do not use microsuction

If the patient:

• has not given consent
• has experienced difficulties with the procedure in the past
• has a history of severe dizziness
• has sensitivity to loud noise (Hyperacusis)
• is unable to keep their head still
• is prone to unpredictable head movement

Precautions

Consideration should be given to the patient’s age: there is no upper or lower age limit for microsuction, but each patient should be assessed in an individual and holistic manner.

Children

Children may require microsuction but may be unable to keep their head still or may be fearful of the procedure. In this instance it is advisable to give serious thought to the necessity of the procedure and whether treatment may hinder any future care needed.

Equipment Used for Wax Removal

It is not recommended to use manual/metal syringes or the Propulse 1.

It is recommended that practitioners should use the Propulse II, III, NG or G5 irrigators.

If there is doubt about the patient’s hearing, an audiological assessment should be made.

Providing they meet certain criteria older adults with a bilateral hearing loss can be referred directly to the Audiology Department.  Patients with a unilateral loss should be referred to ENT.

Advice and Guidance can also be sought via NHS e-Referrals. If any abnormality is found refer to ENT Outpatient Department

Guidance in Ear Care