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How community pharmacies can tap into the ear care service market

Earwax removal is no longer offered by most GPs, so patients are increasingly turning to community pharmacies for advice and treatment. C+D considers how to tap into this market

More than two million people a year in the UK experience build-up of earwax that requires removal, according to the National Institute of health and Care Excellence (Nice). As well as being uncomfortable, excessive earwax can cause hearing difficulty and even social isolation and depression. For these reasons, it is important that excessive earwax is removed.

Tapping into gap in provision

Nice guidelines suggest adults should have earwax removed in primary care or community ear care services if:

  • build-up is causing hearing loss or other symptoms
  • the wax could hinder an ear examination
  • an impression of the ear canal is to be performed.

Last year, health minister Edward Argar confirmed that ear syringing is no longer one of the core services GPs are obliged to provide, and so increasing numbers of patients are asking community pharmacy teams for help.

Even in areas where GP surgeries continue to provide earwax removal as an enhanced service, the COVID-19 pandemic has resulted in some face-to-face appointments being suspended. In some cases this has included earwax removal.

As a result, pharmacies have an increased opportunity to help people with this condition.

Identifying patients

As the first ‘port of call’ for people with many different ailments, community pharmacy teams are well placed to identify and target customers who may be experiencing excessive earwax. For example, a build-up of earwax is more likely in older people and users of hearing aids and earphones, Nice suggests.

Symptoms of earwax build-up include:

  • Dizziness or feeling sick (vertigo)
  • Tinnitus
  • Sensation of blocked ears
  • Earache
  • Itchiness
  • Loss of hearing.

Source: Earwax build-up - NHS (

Pharmacists operating an ear care service are therefore in an ideal position to check if patients reporting these symptoms are affected by a build up of earwax or blockage.


Earwax build-up is usually initially managed by the patient with ear drops. Olive oil may be used to soften the earwax and this may help with some of the symptoms. Softening the earwax may enable the earwax to fall out of by itself. Medical grade olive or almond oil can be used by applying 2-3 drops into the ear canal, 3-4 times per day for approximately 3-5 days. The earwax may then gradually fall out over two weeks.

Despite this, some people will require a healthcare professional to remove the earwax for them.

Manual syringing of earwax is no longer recommended by Nice as a removal option. Instead, practitioners in primary or community ear care services should use an electronic irrigator (flushing with water), microsuction (vacuuming the earwax out under microscope) or another method, such as manual removal using a probe.

Microsuction is an option that is growing in popularity and has the advantage of no upper or lower age limit, as long as the patient is able to stay still throughout the procedure. It is also a useful alternative for people who have tinnitus, a painful or tender ear canal due to infection or evidence of a middle ear infection in the last six weeks, as well as patients with a cleft palate even if it has been repaired.

If irrigation is to be used, the earwax should be softened before treatment, either immediately before or up to five days before treatment. Irrigation may be attempted twice, if after the second attempt it is still unsuccessful the patient should be referred to a specialist ear care service.

Patients should be advised to never try to remove earwax from their own ears, using cotton buds, fingers or anything else. These methods risk causing damage to the ear drum and can result in wax being further pushed in. There is no evidence that advertised products claiming to remove earwax are safe or effective to use and they can result in damage.

Training for earwax removal

Before the service can be offered the practitioner needs to ensure they have appropriate training for that service and they have the necessary equipment. Practitioners also need to be aware of any contraindications to the service for which they are providing.

A variety of  providers offer ear irrigation training, which usually includes an overview of the anatomy and physiology of the ear, common ear problems, how to examine the ear and decide if ear irrigation is the best option for the patient, and how to perform the procedure.

Many providers offer microsuction training, ranging from in-person day courses, costing a few hundred pounds, to a mix of blended learning over a few days, which are more expensive.

The necessary equipment also varies in price, depending on the chosen procedure, with microsuction kits being the most expensive – training providers are most suitably placed to advise on reputable suppliers.

Pharmacists may decide to invest in a patient group direction in order to be able to supply treatments for ear infection, which usually involves completing associated continued professional development to confirm competency.

Providing an earwax removal clinic

Whichever procedure is offered, it is useful to run the clinic using an appointments system, because the starting point is an initial ear examination, which is usually followed by recommendation to use olive oil for 5-7 days before determining if another method of earwax removal is required.

Some pharmacists may decide to charge a nominal fee for the initial appointment to cover the pharmacist’s time and then take this off the cost of earwax removal if the patient returns for treatment—for many private services this starts at around £25-£30 for one ear.

Further information about ear care

Nice recently released an updated earwax clinical knowledge summary, revised March 2021, available here.

The Rotherham Primary Ear Care Centre and Audiology Services’ offer individual guidelines available to download on earwax removal methods, which can be accessed here. This centre also offers a one-day intensive microsuction course for healthcare professionals, combining practical and taught sessions.

This article has been peer reviewed by Jacob Warner, professional practice pharmacist

EarHub’s Sleepwell Silicone Earplugs are ‘perfect’ for light sleepers

EarHub’s Sleepwell Silicone Earplugs can be used by light sleepers to successfully block out unwanted noise, the manufacturer has said.

The earplugs are easy to wear all night long and are designed to be worn over the ear canal so that they form an airtight seal, said EarHub – a trademark of Viator Health.

EarHub said its earplugs reduce noise by 27 decibels, which could make all the difference to getting a restful night’s sleep as opposed to a disrupted one.

These earplugs are reusable and easy to clean with warm soapy water and come in a travel case to keep them clean, EarHub added.

EarHub’s Sleepwell Silicone Earplugs retail at £4.99 for a three-pair pack; £8.99 for a six-pair pack; and £16.99 for a 12-pair pack.

To order, contact GD Cooper, Alliance Healthcare or visit the EarHub website


Otinova Ear Spray’s unique formula can treat ear canal inflammation

Otinova Ear Spray can be used to treat ear canal inflammation, manufacturer ABIGO Medical has said.

This clinically proven antifungal and antimicrobial ear spray has a unique formula – which consists of an astringent mixture of aluminum acetate, aluminum acetotartrate, acetic acid, and water – the manufacturer added.

Both adults and children can use Otinova, but children under the age of five should only do so following a doctor’s advice.

One 15ml-bottle retails at £14.99 but is also available on prescription.

To order, contact Alloga or AAH


Earex ear drop range helps soften hardened ear deposits

Earex ear drops can help patients with hardened earwax and earwax build-up, pharmaceutical company LanesHealth, which owns the brand, has said.

Earex Advance Ear Drops contain urea peroxide, which releases oxygen and works alongside glycerol to break up and soften hardened wax deposits, according to the manufacturer.

Adults who are more likely to suffer from excessive earwax can use the advanced ear drops, but the product is also suitable for children following medical advice, it added.

Earex Olive Oil Ear Drops, instead, can be used in children aged five and over and are suitable for children under five following medical diagnosis. This product contains medicinal grade olive oil, which is a natural lubricant that gently softens and removes earwax, the manufacturer explained.

One 12ml-bottle of Earex Advance Ear Drops retails at £4.99, while the recommended retail price of a 10ml-bottle of Earex Olive Oil Ear Drops is £4.07.

To order, contact AAH, Enterprise, Lexon, Numark, or Johnson Brothers NI


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