HNY Policy and Pathway Repository - York

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.

None provided

Management

Self-treatment should be with olive oil or sodium bicarbonate 5% (OTC) 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)
Wash your hands.
Warm the drops to body temperature by holding the container in your hands.
Tilt the affected ear up or lie on your side.
Pull the ear upward and backwards.
Put the drops in your ear.
Gently massage the small skin flap (tragus) over the ear to help the drops reach the ear canal.
Keep the ear in this position for a few minutes
 

Syringing

Should usually be attempted in general practice before referral for micro suction, 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.
   

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

Indications for microsuction referral

• Presence of a perforation
• Referral will be necessary in cases where the above does not work.
   

Information to include in 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
• Smoking status

Patient information leaflets/ PDAs

• http://www.patient.co.uk/health/earwax 
• http://www.patient.co.uk/medicine/sodium-bicarbonate-ear-drops 
   

References

• http://www.patient.co.uk/health/earwax 
• T Aung and GP Mulley ’10-minute consultation: Removal of ear wax’ 2002;325:27
• Earwax; NICE CKS (May 2012) • Loveman E, Gospodarevskaya E, Clegg A, et al; Ear wax removal interventions: a systematic review and economic evaluation. Br J Gen Pract. 2011 Oct;61(591):e680-3. doi: 10.3399/bjgp11X601497.