IFR Datasheet

Policy Category Criteria Based Access (CBA)

IFR Datasheet

Commissioning decision

The CCG will provide funding for ear wax removal via microsuction for people who meet the criteria defined within this policy.

Access Criteria

                    

Policy Statement 

The CCG will provide funding for ear wax removal via microsuction for patients who meet at least one of the following criteria:

  • There is a foreign body, including vegetable matter, in the ear canal that could swell during irrigation

OR

  • The patient has previously undergone ear surgery (other than grommet insertion that have been extruded for at least 18 months), including radical mastoidectomy

OR

  • The patient has a recent history of otalgia and / or middle ear infection (in the past 6 weeks)

OR

  • The patient is currently suffering from acute otitis externa

OR

  • The patient has a current perforation of the tympanic membrane or history of ear discharge in the past 12 months

OR

  • The patient has had previous complications following ear irrigation including perforation of the ear drum, severe pain, deafness or vertigo

OR

  • The patient has cleft palate, whether repaired or not

OR

  • The patient only has hearing in one ear and that is the ear to be treated, as there is a remote chance that irrigation could cause permanent deafness OR

  • Two attempts at irrigation of the ear canal but this have been unsuccessful in clearing the wax

Rationale:

Ear wax is a normal build-up of dead cells, hair, foreign materials such as dust, and natural wax which forms a protective coating on the skin in the ear canal. Sometimes a plug of ear wax may form. This is not a serious problem and only needs to be removed it if is causing symptoms such as hearing loss or earache, or causing problems when fitting a hearing aid.

Ear drops (such as olive oil or sodium bicarbonate) are available to purchase from pharmacies and will clear the plug of ear wax in most cases. Ear drops are therefore recommended as the first treatment by the National Institute for Health and Care Excellence (NICE). Where ear drops fail to resolve the problem ear wax can be removed in primary care via ear irrigation using an electronic irrigator, which is usually effective at clearing the wax.

For a small group of people ear irrigation is not appropriate, for example because the patient has another ear condition that irrigation could make worse, and should therefore not be used. This policy describes the groups of patients where this applies. These patients may have wax removed via microsuction. In addition there may be occasions where ear irrigation is unsuccessful. If irrigation is unsuccessful on two occasions, in line with NICE guidance, microsuction may be considered to remove the wax.

Glossary:

Mastoidectomy – A mastoidectomy is a surgical procedure that removes diseased mastoid air cells. The mastoid is part of the skull located behind the ear. It is filled with air cells made of bone and looks like a honeycomb. The diseased cells are often the result of an ear infection that has spread into the skull. The procedure is also used to remove abnormal growth of the ear known as cholesteatoma.

Otitis externa – Otitis externa is a condition that causes inflammation (redness and swelling) of the external ear canal, which is the tube between the outer ear and the ear drum.

Tympanic membrane – The tympanic membrane is also known as the ear drum. It is thin layer of tissue that receives sound vibrations from the outer air and transmits them to the auditory ossicles, which are tiny bones in the tympanic (middle-ear) cavity.

Grommet insertion - Grommets are tiny tubes which are inserted into the eardrum. They allow air to pass through the eardrum, which keeps the air pressure on either side equal. The grommet usually stays in place for six to 12 months and then falls out.

Otalgia – Otalgia is also known as ear ache and can originate in the ear, the ear canal, or the outer ear.

Evidence base:

NICE Clinical Knowledge Summary (CKS) – Earwax (July 2016) https://cks.nice.org.uk/earwax#!topicSummary

NICE Guideline (NG98) – Hearing Loss in adults: assessment and management (June 2018)  https://www.nice.org.uk/guidance/ng98

For further information please contact GLCCG.IFR@nhs.net

Date of publication

11th November 2019

Policy review date

November 2020

Consultation n/a

Consultee

Date

Clinical Programme Group (ENT) January 2018
GHNHSFT (via CPG) January 2018
Has the consultation included patient representatives? Lay members within the CPG

Policy sign off

Reviewing Body

Date of review

Effective Clinical Commissioning Policy Group

June 2019

Quality and Governance Committee

8th August 2019