Treatment of impacted ear wax: a case for increased community-based microsuction.

Abstract

Excess earwax is a very common problem, with figures estimating a prevalence of between 700 000 and 2 million adults in England and Wales. Although wax build up can occur in any individual, risk factors include anatomical deformity, hairs in the external canal, physical barriers to wax excretion, dermatological conditions affecting the ear, use of cotton buds, and increasing age (Box 1).1 Requests for the removal of ear wax are a very common reason for presentation in primary care. In the US, approximately 150 000 wax removals are performed each week.2 A survey of GPs in Edinburgh by Sharp et al put estimates at nine patients per month per doctor, equating to two patients per week.3 A more recent study suggested that 2.3 million ear irrigations are performed in England and Wales every year.4 Box 1 ### Risk factors for cerumen impaction View this table: Funding for treatment of impacted earwax is variable across clinical commissioning groups (CCGs). National Institute for Health and Care Excellence(NICE) guidance recommends ear wax removal should be performed in primary care,5 although without a commissioned service, GPs are under no obligation to do so. The funding for these additional services is variable by CCG area, with many practices now opting out of providing irrigation due to cost, high service demand, and safety implications. High set up cost and training requirements make provision of microsuction at individual practice level unfeasible, however many CCGs have funded community-based microsuction services. Access is usually restricted based on NICE criteria for …