Introduction
The RHCYP does not offer an ear dewaxing service.
Ear wax is physiological and does not usually need to be removed.
Ear wax is normal and healthy. It has antibacterial properties and helps keeps the ear canal supple and clean. It does not need to be removed unless it is masking problems. It is extremely rare for ear wax to be occlusive enough to cause hearing loss.
Potential problems could be:
- Hiding underlying cause for hearing loss. It might not be possible to visualize the TM and thus diagnose OME
- Hiding underlying cause for infection. Infection itself should be obvious.
Primary care management and referral guidelines
If hearing loss is suspected: Refer to paediatric audiology
If infection is suspected: Treat infection appropriately (topical ear drops for otitis externa +/- oral antibiotics if acute otitis media). If infection does not settle refer to ENT (but not for wax removal!)
If wax removal is desired – see Primary Care management Tab
Primary care management and referral guidelines
If hearing loss is suspected: Refer to paediatric audiology
If infection is suspected: Treat infection appropriately (topical ear drops for otitis externa +/- oral antibiotics if acute otitis media). If infection does not settle refer to ENT (but not for wax removal!)
If wax removal is desired:
Primary care nurse irrigation. This is a well established and generally safe procedure. There is a small risk of it leading to otitis externa and very rarely (1:1000 or less) of TM perforation. Ideally the patient should apply oil to the ear twice daily for two weeks prior to the procedure. It is safe for children and generally well tolerated. RHCYP does not have facilities for ear irrigation
Not recommended in: persistent TM perforation or grommet, previous myrigoplasty/tympanoplasty/mastoidectomy, only hearing ear.
Secondary care microsuction. This is a well established and generally safe procedure but requires specialist training and equipment so is expensive. It is noisy, time consuming and can be distressing for children, which increases the risk of injury. Even young children will tolerate irrigation but mostly not microsuction.
Sodium bicarbonate ear drops (can be bought OTC), to be used twice daily for one to two weeks, are the most reliable and cheapest way of dissolving wax
Oil drops are very good at softening wax prior to irrigation or microsuction but not good at actually removing it
