Many have risked injury and hearing loss by turning to dangerous methods of ear wax removal, a report has found, despite pharmacies increasingly offering the service.

In a Royal National Institute for Deaf People (RNID) survey of 1,491 people with ear wax build-up, 66% said that they had been told that ear wax removal was no longer available on the NHS, and more than a quarter said that they could not afford to get their ear wax removed privately.

While 66% of survey respondents said that they did not feel confident removing their own ear wax, 71% said that they had attempted it – which the RNID described as ‘concerning’ as it suggested that ‘existing barriers to treatment caused them to resort to self-removal’.

Of these, 76% reported using ear drops, but many reported using methods classed as dangerous, including hair clips, paper clips, toothpicks, cotton buds, and Hopi ear candles – despite these methods contravening NICE advice never to insert objects into the ear.

The RNID said that private ear wax removal, costing anywhere from £50-100, is likely to be ‘beyond the means of most households’, especially since some people need to have their wax build up removed as many as three or four times a year.

NPA professional services development manager, Mathew Peters, highlighted that an increasing number of community pharmacists are offering ear health and wax removal services, ‘to meet the growing needs of their patients’ as many GP practices are no longer offering such services.

He said many pharmacists used micro-suction method which is far safer than the practice of syringing. He added: ‘Offering this service through community will help to alleviate significant NHS waiting lists for ear wax removal services, freeing up GP time and referrals into secondary care.’

Mr Peters also highlighted that in some areas, the NHS is running trials to commission this service to be delivered through community pharmacy. In South West London, 20 community pharmacies have been commissioned to deliver ear wax removal in partnership with TympaHealth.

The Pharmacist has approached NHS England for more details on the trials.

The RNID also recommended that ear wax removal services be brought back into primary care or community settings, and that the Department of Health and Social Care, NHSE and local health bodies to explore new models for delivering services.

‘Extremely dangerous’

Franki Oliver, audiology adviser at the RNID, said that Hopi ear candles are ‘extremely dangerous’ ‘as they can cause burns and damage to the eardrum’, and that they are strongly advised against by the NHS, RNID and other hearing charities.

In the RNID survey, after attempting self-removal, 20% found their symptoms resolved, 55% noticed no difference, 7% said that their symptoms got worse and 3% said that that they caused themselves injury that required medical attention – including a perforated ear drum, bleeding, ear infections, and a foreign body stuck in the ear.

Some RNID survey respondents were sent to hospital to have their wax build-up removed on the NHS, which the RNID said was ‘untimely’ and ‘inconvenient’ for patients, and resulted in ‘wasted time and resources, and unnecessary extra costs to the NHS’.

Many respondents reported symptoms associated with ear wax blockage, such as hearing loss (73%), tinnitus (37%), earache (48%), and dizziness (23%).

They also reported impacts on wellbeing and mental health, including loss of independence, feeling isolated, and difficulty communicating with others.

The RNID said that barriers to ear wax removal presented a particular problem for hearing aid wearers and those who needed to access audiology appointments.

It found 36% of respondents wore hearing aids, and many reported that they were unable to wear their hearing aids due to ear wax blocking the hearing aid tubes (preventing them from working), regular ear infections, and excessive feedback (‘whistling’).

Additionally, 11% of all respondents stated that they were unable to have an essential audiology procedure, such as a hearing test or ear mould impression due to too much ear wax.

‘Current ear wax service offering not good enough’

Crystal Rolfe, associate director for health at RNID, said that the current service offering ‘isn’t good enough’.

She said: ‘We’ve heard of people in agony with pain and depressed at the lack of support they’ve received from health professionals. Some people are unable to leave the house or are left using a notepad to communicate.

‘Someone with ear wax build-up used to be treated in a week at their GP, but now the service has been withdrawn people who can’t afford private treatment are left with no options. This isn’t good enough. Ear wax removal services must be available on the NHS for everyone who needs them.’

The RNID also said that the NHS should publish clear information on how people can safely manage ear wax build-up themselves at home.

The RNID report concluded: ‘Our findings show that existing advice on self-management is not consistently applied, and, even when followed, does not appear to resolve the problem for many people. For those that attempt self-management but still need to seek professional treatment, very few are able to access NHS ear wax removal services.

‘These findings support the need for consistent advice on self-management of ear wax, and steps to take should the first line of treatment be unsuccessful.