G_CS_31 Ear Care Guidelines
The contents of this document are based on Guidance for Ear Care published by Rotherham Primary Ear Care Centre which were developed by the Action on ENT Steering Board (2002) and were revised by the Primary Ear Care trainers - Rotherham Primary Ear Care Centre (2008). The document Guidance in Ear Care has been endorsed by the Royal College of General Practitioners, The Royal College of Nursing and the Medical Devices Agency. Reference: http://www.earcarecentre.com
Ear Wax or excess cerumen is a common problem affecting approximately one third of adults in the UK (Kraszewski, 2008). The Institute of Hearing Research (2009) estimates that over half of people aged 71-80 have some degree of hearing loss and that 55% of people over the age of 60 experience some deafness or are hard of hearing (Royal national Institute for Deaf people, 2008). Nursing literature also identifies that a major cause of hearing impairment is due to impacted cerumen resulting in itchiness, discomfort and earache (Rodgers, 2009; Kraszewski, 2008).
A build-up of wax is more likely to occur in older adults and patient with learning difficulties, hearing aid users, people who insert implements into the ear or have a narrow EAM. A build-up of wax may also occur as a result of anxiety, stress and dietary or hereditary factors. Excessive wax should be removed before it becomes impacted, which can give rise to tinnitus, hearing loss, vertigo, pain and discharge. If it is removed due to the presenting complaint of hearing loss, ascertain whether good hearing is restored after treatment or if the patient would benefit from a formal assessment by the ENT surgeon or Audiologist. Older adults with a bilateral hearing loss can be referred back to the GP for assessment and possible referral to the Audiology Department (Rotherham primary Ear Care Centre, 2008)
Despite non invasive interventions being carried out first there are occasions when ear irrigation is required. Ear irrigation is an invasive procedure with the potential to cause discomfort or injury (Cook 1998 in Kirklees) and therefore must only be considered when other conservative methods of wax removal have failed (e.g. the use of softeners). Risk associated with irrigation include tympanic membrane perforation and otitis externa.