Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Hearing loss in adults, assessment and management: summary of NICE guidance

BMJ 2018; 361 doi: (Published 22 June 2018) Cite this as: BMJ 2018;361:k2219
cropped thumbnail of infographic

Hearing loss: triaged referral

A summary of new NICE guidelines

Rapid Response:

Re: Hearing loss in adults: getting earwax removed is a problem

Earwax is unglamorous, but clear ears make a huge difference to many patients’ hearing and so to their social functioning. It is good that NICE has addressed the problem. But given that the evidence on how best to manage it is so weak and the options so limited, there is little in the guidelines to overcome the current barriers faced by patients who may have earwax.

Firstly, no-one, not even a doctor with an otoscope, can see down their own auditory canal. Someone who knows what they are doing and seeing has to check whether there is a problem with wax. And this may be needed every few months.

Secondly, getting to see a suitable health professional is rarely straightforward. Some GP practices may have a slick service for earwax removal. If they do they need to publicise it, because getting your earwax removed in general practice can be a frustrating exercise. First an appointment with a GP to check your ears (non-urgent, so in three weeks time, maybe). Then another wait for an appointment with the nurse who is trained to remove it. That’s two visits. And electronic irrigators or microsuction devices are costly. How many practices have them?

A few NHS walk-in clinics appear to offer ear syringing but it requires an effort to find out if they do (I’ve tried). Private clinics charge around £80.

Hospital audiology services require a referral and I wonder how many are geared up to open access so patients who feel their wax may be building up can get their ears checked, and removal of the wax if necessary.

No surprise that people turn to self-help. Amazon offers Hopi candles, ear picks, olive oil drops and a variety of devices for actively removing wax including syringes. How safe are these? How effective?

If you run an efficient and effective service, please let us all know how you do it!

Competing interests: No competing interests

03 July 2018
Judith H Harvey
Retired GP
London NW8