Ear Wax Removal

Scope

This guideline covers the management of troublesome ear wax in adults and children.

Please note pre-referral criteria are applicable to this CRG.

Ear wax should be removed in Primary Care in most circumstances.

Referral Criteria
  • Prior primary care management must have been undertaken:
    • 5-7 days of sodium bicarbonate or olive oil drops(unless current perforation)
    • Try irrigation twice unless contraindicated

An individual may be referred for microsuction if they suffer from impacted (build-up of) wax and irrigation is contraindicated (as below).

  • Contraindications to irrigation include:
    • Perforation within 12 months
    • Recently active acute or chronic otitis media
    • Recurrent otitis externa
    • Presence of a mastoid cavity
    • Presence of grommets (Ears can be irrigated if previous grommets have been inserted provided they have extruded and drum has healed)
  • Microsuction may also be considered where there is an inability to co-operate with ear irrigation and/or the use of oil or ear drops or where there have been repeated unsuccessful attempts at ear irrigation.

Referrals for microsuction should detail the prior primary care management. Referrals submitted without this information will be returned.

Individual Practice policies for contraindications to ear wax removal will be overridden by this CRG criteria unless the Clinician gives sufficient clinical information for an informed decision to be made at triage.

Management

  • 5-7 days of sodium bicarbonate or olive oil drops (unless current perforation) see 12.1 Ear
  • Try irrigation twice unless contraindicated
  • Contraindications to irrigation include:
    • Perforation within 12 months
    • Recently active acute or chronic otitis media
    • Recurrent otitis externa
    • Presence of a mastoid cavity
    • Presence of grommets (Ears can be irrigated if previous grommets have been inserted provided they have extruded and drum has healed

Note: Prior to attending Audiology for a hearing test the ears must be completely clear of wax. If long delay before audiology appointment ask patient to return to check ears clear of wax a week before appointment.

Referral

Ear wax should be removed in Primary Care in most circumstances.

Referral Criteria

  • Prior primary care management must have been undertaken:
    • 5-7 days of sodium bicarbonate or olive oil drops(unless current perforation)
    • Try irrigation twice unless contraindicated

An individual may be referred for microsuction if they suffer from impacted (build-up of) wax and irrigation is contraindicated (as below).

  • Contraindications to irrigation include:
    • Perforation within 12 months
    • Recently active acute or chronic otitis media
    • Recurrent otitis externa
    • Presence of a mastoid cavity
    • Presence of grommets (Ears can be irrigated if previous grommets have been inserted provided they have extruded and drum has healed)

Referrals for microsuction should detail the prior primary care management. Referrals submitted without this information will be returned.

Individual Practice policies for contraindications to ear wax removal will be overridden by this CRG criteria unless the Clinician gives sufficient clinical information for an informed decision to be made at triage.

Referral Instructions

Referral to ENT

e-Referral Service Selection

  • Specialty: ENT
  • Clinic Type: Ear
  • Service: DRSS-Western-ENT- Devon CCG-15N
Referral to ENT for children

e-Referral Service Selection

  • Specialty: Children's & Adolescent Services
  • Clinic Type: ENT
  • Service: DRSS-Western-ENT - (Children)-Devon CCG-15N

Referral Forms

DRSS referral form

Supporting Information

Patient Information

MyHealth patient information - ear wax build up

Evidence

Ear syringing and aural care - Nursing Times.net

Pathway Group

This guideline has been signed off by the Western Locality on behalf of NEW Devon CCG.

Publication date: November 2015
Amended: October 2016

 

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