It is becoming more common for GP practices not to provide a wax removal service yet the National Institute for Clinical Excellence (NICE) recommends that wax removal should be offered in the community. A Government Minister has stated that the removal of earwax is no longer one of the core services GPs are obliged to provide. Ear wax can be a simple problem causing a blocked feeling in the ear or can cause debilitating problems such as hearing loss, vertigo, tinnitus, pain, discharge, infection and a cough.  These are significant symptoms, which can have an adverse effect on our quality of life and also have implications on our health and safety. There is a link between social isolation and hearing loss and reduced cognitive function caused by wax impaction.
 
There is evidence that impacted wax is present in one in ten children, 1 in 20 adults and more than one third of older adults and people with a learning disability. In the U.K. it is estimated that 2.3 million people annually have problems with ear wax and due to the lack of routine ear examinations this number is likely to be much higher. Getting ear wax removed on the NHS is a real problem and a frustration to patients because of a lack of availability. Untreated earwax has adverse implications to health and will also increase costs to the NHS with antibiotic prescribing for ear infections, referrals to ENT departments and costs resulting from vertigo, tinnitus and hearing loss.
 
Patients with normal ears and normal wax do not need to be referred to the hospital Ear, Nose and Throat department. Unless there is a health reason for not performing irrigation with water, a patients’ ear wax should be managed in the community. If that service is not available patients are often told that they should continue with drops or there are private services that will remove wax at costs from £80 to £300 for both ears. It appears that ear care in some areas is being covertly privatised.
 
There is a wealth of research looking at the increased incidence of wax build up in older adults and there is conclusive evidence of the association between hearing loss and social isolation. It is universally recognised that hearing does decrease with age. Wax build up occurs over time so the gradual deterioration in hearing it has caused may be considered by an older person as part of the natural process of ageing. Wax obstructing the ear canal compounds this problem and suddenly an acceptable level of reduced hearing deteriorates to cause significant hearing loss. Impacted wax is the commonest cause of a conductive hearing loss and this is a reversible hearing loss that is easily dealt with but is dependent on whether this procedure is provided locally and promptly. Hearing loss can lead to isolation, confusion, increased accidents at home and depression. It has been researched that there was an improvement in the cognitive function of patients with dementia after wax removal. As this group of patients do not ask for their ears to be examined it is important to detect the wax impaction with annual ear assessments making every contact with the vulnerable older adult an opportunity to assess their ears and hearing.
 
I am making an impassioned plea, it may be described by a Health Care provider as just ear wax but to the patient it can be a source of debilitating symptoms and as health care professionals we are obliged to ensure that there are options of removal immediately for the patient. Every surgery or group of surgeries should have a nurse or health care assistant trained and willing to carry out irrigation with water. Become part of the fight for better ear care for all and make wax removal accessible locally in the NHS.