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

AND

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