Aural Microsuction (for patients aged 10+ years)

Threshold

Ear wax is completely normal and healthy.  If wax builds up, most people can clear existing wax and prevent future wax build up through self-management.

If a person can self-manage and there are no contraindications, they should be advised to self-manage.  If the patient requires microsuction, they will need to be directed to private providers for this service.

First line treatment – Ear wax softeners – olive oil can be used 3-4 x daily for 7-10 days, if no response

Second line treatment – use sodium bicarbonate for 3-5 days if required.

Note: Ear drops should not be used if there is suspicion of a perforated tympanic membrane, patients with a perforation as a complex patient.

Third Line treatment – Aural microsuction is considered a 3rd line treatment for symptomatic hearing loss -total occlusion.

NWICB will fund the aural microsuction for the removal of earwax if one of the following criteria is met:

• Patients for whom self-management is not recommended, due to having complex ears, e.g. an ear drum perforation, documented recurrent ear infections.
• Patients who are unable to self-manage e.g. those with learning disabilities, or disability and such as registered blind or partially sighted and do not have carer support, although self-management should be attempted before considering referral to microsuction providers.
• A cleft palate – repaired or not.
• Patients who have tried self-management, but for whom wax continues to prevent accurate, timely hearing assessment and hearing aid management.
• The person wears a hearing aid, and an impression needs to be taken for a mould, or wax is causing the hearing aid to whistle.
• Symptoms have persisted despite ear drops AND earwax is totally blocking the ear canal AND/OR where wax is preventing ear examination/visualisation of the eardrum in a secondary care or specialist setting

Norfolk and Waveney ICB recognise the considered expert advice of NICE however, there is also a duty to prioritise spending of a finite resource and have developed this clinical threshold policy giving the most equitable and effective use of NHS resources.

Scenario: Management | Management | Earwax | CKS | NICE

Cases for Individual Funding Consideration (Patients who do not meet the policy criteria)

On a case to case basis, patients might be eligible for surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.