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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 Page | 2 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 Page | 3 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 Page | 4 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 Page | 5 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 Page | 6