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Management policy/procedures document

Management policy/procedures document

Management policy/procedures document


Treatment should only be given in line with these general principles.

• Clinicians should assess their patients against the criteria within this policy
prior to a referral and/or treatment

• Treatment should only be undertaken where the criteria have been met and there is evidence that the treatment requested is effective and the patient has the potential to benefit from the proposed treatment. Where the patient has previously been provided with the treatment with limited or diminishing benefit, it is unlikely that they will qualify for further treatment

• Patients should be made aware that the assessment does not mean that they will be provided with and treatment will only be provided where it can be demonstrated that the patients meets the criteria to access treatment in this policy

• Patients should be advised being referred from GP or other services does not confirm that they will receive treatment for a condition as a consent discussion will need to be undertaken with a clinician prior to treatment

The policy does not apply to patients with suspected malignancy who should continue to be referred under 2 week wait pathway rules for assessment and testing as appropriate

A referral for ear wax removal for patients will not receive treatment for any of the criteria set out below:

• Undergoing regular appropriate treatment, such as de-waxing a mastoid cavity
• There is a foreign body, including vegetable matter, in the ear canal that could sIll during irrigation and requires urgent removal because of risk of infection etc.

• If they require micro-suction because of anatomical abnormalities and wax removal is deemed unsuitable for the primary care micro suction service
• Has previously undergone ear surgery (other than grommets insertion that have been extruded for at least 18 months) and wax removal is deemed unsuitable for the primary care micro suction service
• Has a recent history of Otalgia and /or middle ear infection (in past 6 Ieks)
• Acute Otitis Externa and wax removal is deemed unsuitable for the primary care micro suction service
• Has a current perforation or history of ear discharge in the past 12 months and wax removal is deemed unsuitable for the primary care micro suction service
• Has had previous complications following ear irrigation including perforation of the ear drum, severe pain, deafness, or vertigo and wax removal is deemed unsuitable for the primary care micro suction service
• Ear drops have been unsuccessful and irrigation and micro-suction in primary care are contraindicated or
• Patients ear wax has not been removed successfully by two attempts at electronic irrigation and one attempt at primary care micro-suction

Furthermore, NICE have based their contra-indications on irrigation and recognise that where irrigation is contra-indicated or has been unsuccessful for a subject or is unavailable, other methods such as microsuction or manual removal using simple extraction tools such as a curette may be considered (NICE 2018, NG98).

Methods of ear wax removal

This guidance includes wax removal using:
• simple extraction instruments such as loops, curettes and forceps
• electronic water irrigation machines
• suction devices

This guidance does not include wax removal by:
• manual syringing
• self-irrigation
• Hopi candles

Do not offer manual syringing to remove earwax (NICE 2018, NG98). This method is not considered to be safe based on evidence assessed by NICE. (Please note that manual syringing and irrigation are not the same process). NICE recommends further research into the safety of self-irrigation and therefore this should also not be offered. The use of Hopi candles is also considered by NICE to beinappropriate and should not be offered.

• It is important to note that aural care practitioners should work within their scope of practice at all times and ensure they understand and communicate the risks associated with the specific procedure(s) they offer.
• For example, if only irrigation is offered as a method, then the procedure should not be offered to subjects with the contraindications to irrigation. The individual should be referred to a colleague that provides microsuction or a specialist ear care service or ENT, if appropriate to the condition discovered.

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