Download Ear Wax Removal Adults Criteria Based Access

Ear Wax Removal Adults
Criteria Based Access Policy
Adoption Date: March 2016
Version:
1516.v2
Document Control
Title of document
Ear Wax Removal Policy
Authors job title(s)
IFR Manager
Directorate(s)
SCW CSU IFR
Document status
v.2
Supersedes
v.1.1
Discussion and Recommendation
by the Somerset CCG Clinical
Commissioning Policy Forum
09 March 2016
Discussion and Approval by
Somerset CCG Clinical
N/A
Operations Group
Date of approval
09 March 2016
Publication/issue date
March 2016
Review date
NICE publication or 3 years
following issue
Distribution
SCCG Web Site IFR Page
SCCG GP Pathway Navigator
SCCG Contracts Team - Contract
Variation
SCCG GP Bulletin
Somerset CCG GP Practices
Medical Directors:

Taunton & Somerset NHS FT

Yeovil District Hospital NHS FT

Royal United Hospital Bath NHS FT

United Hospitals Bristol NHS FT

Weston Area Health NHS Trust
Application Form
 Other NHS treatment providers
CBA Policy
Equality and Impact Assessment
20151126 v1a
SCW CSU Ear Wax Removal Policy for SCCG 2015 1516.v2
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TREATMENT MAY BE PROVIDED WHERE PATIENTS MEET THE CRITERIA
BELOW – THIS IS A CRITERIA BASED ACCESS POLICY
THIS POLICY RELATES TO ADULTS
EAR WAX REMOVAL
Date of Issue: March 2016
Ear Wax Removal is subject to this restricted policy.
General Principles
Treatment should only be given in line with these general principles. Where
patients are unable to meet these principles in addition to the specific
treatment criteria set out in this policy, funding approval may be sought from
the CCG Individual Funding Panel by submission of an IFR application.
1. Clinicians should assess the patients against the criteria within this policy prior to
treatment.
2. Patients will only meet the criteria within this policy where 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 and the IFR team should be approached for advice.
Background
Ear Wax Removal:
Treatment in primary care as per Modernisation Agency Ear Care Guidance
Although some people are asymptomatic, the most common symptom from impacted
earwax is hearing loss. People may also complain of:
 Blocked ears
 Ear discomfort
 Earache
 Tinnitus (noises in the ear)
 Itchiness
 Vertigo (not all experts believe that wax is a cause of vertigo)
 Cough (rare and due to stimulation of the auricular branch of the vagus
nerve by pressure from impacted ear wax
SCW CSU Ear Wax Removal Policy for SCCG 2015 1516.v2
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Ear wax may be wet or dry and is a normal physiological substance that protects the
ear canal. It has several functions including aiding removal of keratin from the ear
canal (earwax naturally migrates out of the ear, aided by the movement of the jaw).
It cleans, lubricates, and protects the lining of the ear canal, trapping dirt and
repelling water.
Excessive build-up of ear wax can develop in some people, and the wax can
become impacted. Although wax frequently obscures the view of the tympanic
membrane it does not usually cause hearing impairment. It is only when the wax is
impacted into the deeper canal against the tympanic membrane (often caused by
attempts to clean out the ear with a cotton bud, or by the repeated insertion of a
hearing aid mould) that it is likely to cause a hearing impairment.
Criteria
Patients who are suspected of suffering from malignancy should be referred under
the two week cancer pathway which does not require funding authorisation
a)
b)
c)
d)
Aural toilet to be carried out as appropriate
Undergoing regular appropriate treatment, such as de-waxing a mastoid cavity
If they require microsuction because of anatomical abnormalities
The vast majority of patients presenting with problems to primary care will be
managed in primary care with advice
e) Irrigation may be carried out in Primary Care settings
A referral for ear wax removal in secondary care is only commissioned for patients
meeting the criteria set out below:

There is a foreign body, including vegetable matter, in the ear canal that
could swell during irrigation;
OR

The patient is suffering from significant symptoms due ear wax build up
including hearing loss or pain and the patient’s condition warrants
microsuction:
AND
SCW CSU Ear Wax Removal Policy for SCCG 2015 1516.v2
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
Has previously undergone ear surgery (other than grommets insertion that have
been extruded for at least 18 months);
OR

Has a recent history of Otalgia and /or middle ear infection (in past 6 weeks);
OR

Acute Otitis Externa;
OR

Has a current perforation or history of ear discharge in the past 12 months;
OR

Has had previous complications following ear irrigation including perforation of
the ear drum, severe pain, deafness, or vertigo;
OR

Two attempts at Irrigation of the ear canal in primary care are unsuccessful;
OR

Ear drops have been unsuccessful and irrigation is contraindicated
Patients who are not eligible for treatment under this policy may be considered on an
individual basis where their GP or consultant believes exceptional circumstances
exist that warrant deviation from the rule of this policy. Applications cannot be
considered from patients personally.
Provided these patients receive the full support of their general practitioner, or
clinician, in pursuing their funding request an application may be made to the
Individual Funding Request Panel for consideration.
It is expected that clinicians will have ensured that the patient, on behalf of who they
are forwarding the application for, is appropriately informed about the existing
policies prior to an application to the IFRP. This will reassure the Panel that the
patient has a reasonable expectation of the outcome of the application and its
context.
In order for funding to be agreed there must be some unusual or unique clinical
factor about the patient that suggests that they are exceptional as defined below:

Significantly different to the general population of patients with the condition in
question
SCW CSU Ear Wax Removal Policy for SCCG 2015 1516.v2
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
Likely to gain significantly more benefit from the intervention than might be
expected from the average patient with the condition
If you would like further copies of this policy or need it in another format, such as
Braille or another language, please contact the Patient Advice and Liaison Service
on Telephone number: 08000 851067. Or write to us: NHS Somerset Clinical
Commissioning Group, Freepost RRKL-XKSC-ACSG, Yeovil, Somerset, BA22 8HR
or Email us: [email protected]
References:
1. NICE Clinical Knowledge Summary http://cks.nice.org.uk/earwax#!scenario:1
Approved by (committee):
SCCG CCPF
Date Approved:
09 March 2016
Produced by (Title)
IFR Manager
EIA Completion Date:
20151126 v1a
Review Date:
NICE publication or 3 years following issue
SCW CSU Ear Wax Removal Policy for SCCG 2015 1516.v2
Version:
Undertaken by (Title):
20150923 V2
IFR Co-Ordinator
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