Ear Wax

There is currently a long waiting time for routine care. If the patient has severe otitis externa, microsuction can be accessed as an emergency at St John’s Hospital for patients aged 16 and over by contacting the on-call ENT team via switchboard on 01506 523 000. Children should be discussed with the on-call team at RHSC. 

Secondary Care Microsuction for wax is a well-established and generally safe procedure but requires specialist training and equipment so is expensive. Ideally the patient should apply oil to the ear twice daily for two weeks prior to the procedure for impacted wax.  The service is available at Lauriston Building, Roodlands Hospital, St John’s Hospital and RHSC for older children (absolute minimum six years of age), and is provided by the Nurse Specialist team. Please see below for criteria for referral.

Who to refer:

Patients who have ear wax causing symptoms, where there:

• have been two previous unsuccessful attempts at irrigation or microsuction in primary care
• is persistent TM perforation or a mastoid cavity
• is significant inflammation – otitis externa – not responding to treatment
• has been a previous significant negative experience of irrigation.  

Please note that a history of a previous perforation is not in itself a contraindication to irrigation.

Who not to refer:

Patients who have no contraindication to wax removal in primary care (irrigation or microsuction), require two attempts at primary care wax removal prior to referral. Please see Primary Care Management for more detail.

They also need to have occlusive wax causing symptoms and have maximised self-care: please see the ear wax patient information leaflet. 

How to refer:

Via Sci Gateway to Lauriston / East Lothian Community Hospital / St John’s – ENT – Ear Wax

• Sodium bicarbonate ear drops (can be bought OTC, or self-made!), to be used twice daily for two weeks, are the most reliable and cheapest way of dissolving wax
• Oil drops are excellent at softening wax prior to irrigation or microsuction. Although they do not actually remove wax, once softened it will often just clear itself using the natural ear mechanisms

Most ear wax can be self-managed – please see the NHS Lothian ear wax patient information leaflet, which also gives details about how patients should prepare for ear irrigation.

Primary Care Nurse Irrigation.

Ear irrigation for wax is a well-established procedure in General Practice. There is a small risk of its leading to otitis externa and very rarely (1:1000 or less) of tympanic membrane perforation. Ideally the patient should apply oil to the ear twice daily for two weeks prior to the procedure. 

There is no evidence that repeated ‘routine syringing’ is of benefit and should be avoided as it may also cause unnecessary harm: self-management should always be encouraged.

Long-term weekly application of sodium bicarbonate ear drops after wax clearance helps prevent recurrence and need for further irrigation or microsuction.

The ENT recommendation is that primary care ear wax removal is not needed more frequently than 6-monthly.

Primary Care microsuction

This is for wax removal only, and not suitable for the more complex microsuction undertaken in ENT for otitis externa, mastoid cavities and other ENT complications. It is currently under development in NHS Lothian with plans to have it available to some areas in 2021.

Ear wax PIL 2021