Document type
Clinical pathways
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
Ear Wax Removal | Adults

Ear Wax Removal - Microsuction - Adults Only

Pathway Publish Date: July 2023
Next Review Date: July 2025
First line treatment for ear wax is self-management.  Referral for microsuction should be considered as a last resort.

  • First line advise olive oil for two weeks to soften wax and enable removal
  • Second line advise patient to use sodim bycarbonate drops (over the counter) for three to five days (unless perforated tympanic membrane, also warn patient about potential skin irritation)
  • Advise patient to consider use of an ear bulb for removal of wax.  This is safe and can be purchased from a pharmacist
  • If self-management fails, try ear irrigation unless contra-indications (see pathway)
  • If all above have failed consider referral for microsuction or ENT referral if:
    • There is a foreign body including vegetable matter in the ear canal that could swell during irrigation; OR
    • Patient is suffering significantly from ear wax including hearing loss or pain


  • Has previously undergone ear surgery (other than grommet insertion that has been extruded for at least 18 months) OR
  • Has a recent history of otalgia and middle ear infection (last six weeks) OR
  • Current perforation/ history of ear discharge in last 12 months OR
  • Previous complications following ear irrigation including perforation of ear drum, severe pain, deafness, vertigo OR
  • Two attempts at irrigation are unsuccessful OR
  • Ear drops have been unsuccessful and irrigation is contra-indicated