Aural Microsuction for Patients Aged 10+ Years (Norfolk and Waveney)

NOTE A: Self Care

First line: Purchase over the counter ear drops or spray to soften wax and aid removal.*

• Olive oil or almond oil drops can be used 3-4 times daily for 7 -10 days followed by sodium bicarbonate for 3-5 days if needed.
• Do not advise drops if you suspect the person has a perforated tympanic membrane. Patients with a perforation must be referred to an acute as a complex patient. (see Note E). If a patient has a history of perforation which is now healed and stable, do not attempt drops and refer directly to the community service to be seen as a non-complex patient.
• Warn the person that instilling ear drops may cause transient hearing loss, discomfort, dizziness and irritation of the skin.
• Where there is genuine concern that a patient does not have the means to purchase OTC drops then a prescription can be issued.

* NICE advises use of ear drops 3-4 times a day for 3-5 days. However, it is noted that some clinicians prefer to advise a longer duration of treatment (7-10 days) and two courses of treatment.

NOTE B: Hearing Aid Fitting

• Does the patient wear a hearing aid and need an impression to be taken for a mould, or is wax causing the hearing aid to whistle? If so, complete community ear wax removal referral. To note, presence of wax in tubes/moulds may not always cause a whistle but will drastically reduce the functioning of the hearing aid as the sound will not travel freely.

NOTE C: Community Earwax Removal referral criteria (microscopic suction)

• The patient must be symptomatic (e.g. hearing loss, earache, tinnitus, vertigo, cough suspected to be due to earwax) and wax has not been cleared by first line treatment.

NOTE D: Infection present

• Signs of infection may not always be apparent behind ear wax and microsuction may be required to remove wax to allow treatment of infection. In these cases, refer to an enhanced community provider (NDA/Hear for Norfolk, Chet Valley or Wymondham).
• If infection is suspected and needs microsuction clearance, ensure a swab is taken. This will then be picked up by provider from ICE.

NOTE E: Non-symptomatic, non-complex patients

• Where the patient does not meet the criteria, the patient may fund their own treatment.

NOTE F: Criteria for Complex Patients – refer to Secondary ENT services

• The person has cognitive impairment and/or cannot express their symptoms
• The person has or previously had a chronic perforation of the tympanic membrane. If the person has a history of perforation but this is now healed and stable, they can be referred to the community service as a non-complex patient.
• Has a history of ear surgery
• Where microscopic/endoscopic suction has been abandoned e.g. dizziness, pain
• Granulation tissue
• Pain out of proportion with clinical findings
• Has a foreign body in the ear canal. Note that small foreign bodies (e.g. hearing aid domes or ear buds) may be removed in the community but if sedation is required then patients must be referred to ENT.
• Keratosis Obturans
• Management of Otitis Externa#
• Active Mastoid cavities##

# Patients with otitis externa can be referred to – NDA/Hear for Norfolk, Chet Valley and Wymondham
## Patients with active mastoid cavities can be referred to NDA/Hear for Norfolk and Chet Valley.

Paediatrics

Only enhanced providers will see patients aged over 10 years old.
Patients aged < 10 years will need to be referred directly to the acute trusts.

Table showing current aural microsuction service provision across Norfolk and Waveney