Hearing Loss in Adults: Assessment and Management

Joe, a student, came to see me recently to have wax removed from his ears. He reported that he was finding it difficult to hear in lectures. He thought his ears might be blocked with wax and had already been using olive oil drops for 7 days. Sure enough, when I examined his ears both canals were impacted with wax.

I am always conscious of the risk of doing damage to the ear through irrigation. The most common complication is otitis externa but the risk of serious complication such as perforation is estimated at 1 per 1000. The procedure went well with the satisfying removal of two plugs of wax and the smile that appears on the face of the patient when their hearing is restored.

Does anybody remember the big stainless - steel ear syringes that were used in the past? They looked like something that might be used for cake decoration on the Great British Bake Off. I don’t think I’ve seen one for more than 30 years. I googled ‘ear syringe’ and was surprised they are still available to purchase, good thing then that newly published NICE guideline NG98 Hearing loss in adults: assessment and management advises us not to use them! Electronic irrigators or micro-suction are recommended. Wax removal is a common procedure for primary care nurses but one which promotes a lot of discussion amongst nurses about its benefit verses the risk. NG98 recommends that removal of earwax is offered in primary care or community ear care services. The guideline also helpfully recommends that patients should be referred for specialist intervention after two attempts at wax removal.

Acute Hearing loss is one of the topics covered in the upcoming Hot Topics GP Update course. There are some useful messages in this presentation and the workbook for GPs and nurses, including:

• When does hearing loss require a referral?
• Which specific presentations necessitate urgent specialist review?
• Screening for hearing loss in certain groups such as patients with learning disability or memory loss
• Managing ear wax - more interesting than you might think!

Click here to purchase your ticket to get an update on this topic and many others at our Hot Topics workshops.

This blog was originally written by Lucy Hamilton - Nurse Practitioner & Nurse Education Lead and published via the NB Medical Hot Topics Blog, in June 2018.