Quality statement 1: Earwax removal

Quality statement

Adults with earwax that is contributing to hearing loss or other symptoms, or preventing ear examination or ear canal impressions being taken, have earwax removed in primary care or community ear care services.

Rationale

Earwax build-up can cause hearing difficulties and discomfort, and it can contribute to outer ear infections. It is also important to remove earwax quickly because it can prevent ear examination or ear canal impressions being taken, which will delay assessment and management of hearing loss and underlying pathology. Hearing loss caused by impacted earwax can be frustrating and stressful. If untreated, it can contribute to social isolation and depression. Providing earwax removal closer to home, in primary care or community ear care services, will prevent the inappropriate use of specialist services.

Quality measures

Structure

a) Evidence of referral pathways in place to ensure adults with earwax that is contributing to hearing loss or other symptoms, or preventing ear examination or ear canal impressions being taken, have earwax removal in primary care or community ear care services.

Data source: Local data collection, for example, clinical protocols and documented, locally agreed pathways.

b) Evidence of local arrangements for healthcare professionals to have training to use earwax removal methods.

Data source: Local data collection, for example, training records.

c) Evidence of the availability of equipment to remove earwax in primary care or community ear care services.

Data source: Local data collection, for example, service specifications.

Process

Proportion of attendances of adults with earwax that is contributing to hearing loss or other symptoms, or preventing ear examination or ear canal impressions being taken, in which earwax is removed in primary care or community ear care services.

Numerator – the number in the denominator for which earwax is removed in primary care or community ear care services.

Denominator – the number of attendances of adults with earwax that is contributing to hearing loss or other symptoms, or preventing ear examination or ear canal impressions being taken.

Data source: Local data collection, for example, audit of electronic case records.

Outcome

Health-related quality of life for adults with earwax that has contributed to hearing loss or other symptoms, or has prevented ear examination or ear canal impressions being taken.

Data source: Local data collection, for example, a patient survey.

What the quality statement means for different audiences

Service providers (primary care and community ear care services) ensure that locally agreed referral pathways are in place for removing earwax for adults when it is contributing to hearing loss or other symptoms, or is preventing ear examination or ear canal impressions being taken. Service providers also ensure that healthcare professionals are trained to use earwax removal methods, and that they have access to the correct equipment.

Healthcare professionals (such as audiologists, practice or community nurses and GPs) carry out earwax removal in adults when it is contributing to hearing loss or other symptoms, or is preventing ear examination or ear canal impressions being taken. Methods that can be used include ear irrigation, microsuction or manual removal. Ear irrigation may be contraindicated for some people.

Commissioners (clinical commissioning groups) ensure that they commission services with the appropriate equipment, capacity and expertise to carry out earwax removal for adults in primary or community care.

Adults with earwax that is affecting hearing or causing other symptoms, or needs to be removed so that the ear can be examined or an impression of the ear canal can be taken, have the earwax removed in primary care or community ear care services.

Source guidance

Hearing loss in adults: assessment and management (2018) NICE guideline NG98, recommendation 1.2.1

Definition of terms used in this quality statement

Other symptoms

Although some people are asymptomatic, the most common symptom from impacted earwax is hearing loss. People may also complain of:

  • blocked ears

  • ear discomfort

  • a feeling of fullness in the ear

  • earache

  • tinnitus

  • itchiness

  • irritation of the ear canal leading to cough.

[Adapted from NICE's clinical knowledge summary on earwax, 2016]

Equality and diversity considerations

Access to hearing care services for care home residents was highlighted by the committee as an equality and diversity consideration. It is important that staff are aware that people in care homes have the same right to access healthcare as people living independently in the community. This is stated in the NHS Constitution for England. Housebound people with hearing loss may also have limited access to hearing care services.

Healthcare professionals should adapt their communication style to the person's hearing needs. This will help to ensure that the adult has the opportunity to be involved in decisions about their earwax removal.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible information standard.