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Earwax Removal - Postcode Lottery?

The Guardian have written a great article on this very depressing subject.

Until a few years ago, GPs were responsible for earwax removal. A patient suffering from wax buildup saw their GP to discuss their symptoms, the GP examined their ears and, if wax was confirmed to be the problem, they booked in for syringing with the practice nurse.

Symptoms are deafness, crackling/popping noises deep in the ear, water trapped behind the wax, visible wax at the entrance of the ear canal, perhaps discomfort. The wax can swell when it gets wet, so after a bath or shower you can be temporarily deaf until it dries out. If the ear canal is completely blocked it causes an unpleasant full sensation and distortion of sound or complete blockage of sound.

The ear canal and eardrum are delicate, so the best person to remove it is indeed a qualified person such as a nurse. Perhaps most importantly, GP's can rule out other causes of the symptoms, for instance sudden hearing loss or temporary hearing loss can have alternative causes. Popping noises can be caused by fluid in the middle ear that can lead to infection. Sudden hearing loss can sometimes be treated with medicine if seen within a very tight timeframe, so seeing a GP is absolutely the best course of action to capture these patients and save their hearing in time.

Earwax is not an exciting topic, but it (and the alternative diagnoses) are a medical issue. The system worked well and everyone knew what to do.

Several years ago though, GP's stopped receiving funding for wax removal. This government made the choice that the NHS, free to those in need, would not fund wax removal. This was a bad choice in my opinion, especially as they didn't remove responsibility for wax removal from primary care.

So what happened was that GP surgeries started telling people to try olive oil drops to move the wax. Patients were told that syringing (flushing wax out with water) was dangerous, and could cause infection, that's why they didn't offer it anymore. Overstretched surgeries started advising patients over the phone to try olive oil, without ever examining the patient's ears. Imagine that, you contact the surgery with sudden deafness and are told "it's probably earwax, we don't do syringing anymore so try olive oil". This is not appropriate advice, and the patient could have a serious complaint: a perforated eardrum, viral permanent hearing loss. I shudder to think about the people who have had needless pain and deafness from being dismissed or diagnosed by the receptionist. Phrases like these, that are designed to make patients go away and stop complaining started to be heard in my clinic as patients came to me next.

I'm quite sure that syringing can lead to an ear infection in a tiny number of cases, but the alternatives are worse and a nurse is still the best person to treat you.

Private audiologists sometimes remove wax as a service to their customers. I don't but many do. Patients started contacting us (by now I was in my own private practice and receiving many calls a week asking for help). Audiologists started training up to remove wax via microsuction, and charging for their time. The going rate was £60 or so to vacuum out both ears.

The free market is what it is, so other people joined up to get £60-70 per half hour to remove people's earwax. Where there's brass, and all that. Audiologists realised that if they saw to all the wax demand they wouldn't have time to diagnose and treat hearing loss, so they started training up other members of staff, and they still charged £70 a go, even when it was their juniors (or their admin staff!) doing the removal. Hairdressers, beauty therapists, the occasional private nurse, they all trained up and started charging.

GP's are still responsible for making sure their patients can hear, but they washed their hands of the service. In some ways I don't blame them - they aren't being funded for it - but whereas at the beginning of this mess I could be sure that if I wrote to the GP regarding a vulnerable patient they would be seen, now the advice is:

"Well I can put you on the ENT list but it could be up to three years"

This is absolutely intolerable. These people are being left with deafness which can be resolved in ten minutes. They are not always able to pay £70, and some of them will get repeated blockages they can ill afford to treat. Hearing aid users are sometimes more prone to blockage because they have a device blocking the natural movement of skin/wax. The elderly are more prone to blockage.

Fast forward to 2024 and we are seeing injuries from attempts to remove wax at home. Scary devices are being sold online, and people who perhaps have dexterity problems, cannot read well or have dementia are not heeding the warnings on the devices. Home syringing can cause barotrauma - if you block your ear canal totally and fire water into it, the vacuum you made can rupture your eardrum. Failed attempts are painful and can cause infection. Microsuction (and wax removal in general) is still not regulated, so there are high noise levels being dispensed straight to the eardrums of patients by unqualified staff.

Audiologists are complaining that other people are charging for wax removal, and there are genuine concerns about that, but amid this income-guarding they are missing the point. Until a few short years ago patients could access safe, free care. It was not our remit to remove wax and it isn't the best solution for patients. It is unfair that some people will need to pay £70 every few months forever to receive a poorly regulated and potentially dangerous service. It is unfair that those who cannot afford it will suffer deafness and discomfort. Alternative causes of permanent deafness will be missed, new noise-related damage and tinnitus will be caused.

It is ridiculous that people are being passed from pillar to post when the original service was fast, free, efficient and easy. The government have tried to save money and made things infinitely more expensive and difficult for hundreds of thousands of people. If they wanted to start charging patients they could do that, but this mess was avoidable. It should be put back how it was without delay, and they should find another way to save money.

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