Condition or Treatment Removal of Ear Wax in secondary care



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General Commissioning Statement


Condition or Treatment

Removal of Ear Wax in secondary care


Commissioning Threshold

Ear wax removal is normally carried out in primary care.
Refer to secondary care only if:

  • Conservative treatments including irrigation are unsuccessful (following initial softening with ear drops for at least 14 days)

OR

  • Conservative treatments including irrigation are contraindicated. The contraindications are:

    • Complications following this procedure in the past

    • Current perforation of the tympanic membrane

    • A history of healed perforation of the tympanic membrane in the last 12 months

    • Ear surgery in the past (apart from grommets that have come out at least 18 months previously and you have been discharged from the hospital ear department)

    • A cleft palate (even if it has been repaired)

    • A current middle ear infection or a history of middle ear infection in the previous six weeks

    • A history of current or recurring otitis externa

    • Hearing only in one ear, if it is the ear to be treated

    • Inability to cooperate with the procedure (eg confusion, agitation, young children, some people with learning difficulties




Referral guidance

Procedure of limited clinical value
Exceptional cases can be referred to the CCGs Individual Funding

Request Panel for prior approval.
Please find form here


Effective from

01/10/2016

Summary of evidence /

Rationale



A build-up of earwax is a common problem that can often be treated using eardrops bought from a pharmacy.

NICE Clinical Knowledge Summaries (CKS) recommends using drops for 3–5 days as first-line management, with the aim of avoiding irrigation whenever possible.



CKS does not recommend irrigation without prior use of a softening agent as extra force may be needed which is more likely to cause trauma
http://cks.nice.org.uk/earwax#!management

Date

01/10/2016

Review Date

01/10/2017

Contact for this policy


Dr. Rick Sweeney

GP/Governing Member

rick.sweeney@nhs.net





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