Ear irrigation appointments were a routine part of a general practice nurse's (GPN's) day; however, due to COVID and misconceptions, ear irrigation has not been happening. Having earwax is part of the ear's natural process of cleaning and protection, and, in most cases, it does not need to be removed. The National Institute for Health and Care Excellence (NICE, 2021), however, recommend offering ear wax removal if: earwax is contributing to hearing loss or other symptoms; the tympanic membrane is obscured by wax but needs to be viewed to establish a diagnosis; or an impression needs to be taken of the ear canal.
We know if left untreated, symptoms of ear wax build up can lead to a greater risk of ear infections, social isolation, depression and sometimes an increased risk of falls. This is more evident during COVID, causing added isolation for older people, especially those who have reduced hearing due to wax, and who rely on their phone to contact family, friends and loved ones, and television and radio for companionship. I am sure we can all empathise and have our own stories to share.
Interestingly, there is no Royal College of Nursing (RCN) guidance per se on ear irrigation. To confirm, it is not classified as an aerosol generating procedure (AGP) for the purposes of COVID-19 or other respiratory infections. While droplets may be expelled, it does not involve the respiratory tract (UK Health Security Agency, 2021). Although not an AGP, ear irrigation is a widely litigated practice and further discussions are needed.
Local commissioners are responsible for arranging for the provision of medical services to the extent they consider necessary to meet the reasonable needs of the people for whom they are responsible. Therefore, commissioners should ensure that there is appropriate access to ear wax removal services, where these are necessary and clinically appropriate for a patient, which are free at the point of use (Argar, 2021). Do you know what commissioned services are available for patients in your area?
Is it right that ear irrigation is no longer offered as routine practice? Is it right that some areas have commissioned microsuction services at scale (how long are the wait times?) and many more have not? Is it equitable? Should ear irrigation be discouraged? We really want to hear your thoughts. Let us know at pn@markallengroup.com
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