WAX IN YOUR EARS?
You may feel that ears blocked with wax is a trivial issue when compared to COVID, long hospital waiting lists, lack of domiciliary care, etc. However, for those who are affected it is a significant problem; they have depended on their local GP practice to treat them when required, and they are now in limbo. The issue was first raised about two years ago, but more so during 2020 and lockdown, when practices started saying they couldn’t perform ear irrigation because of the COVID infection risk. Then last autumn it became evident that it was a bigger issue, being told that ear treatment had ‘never been in the GP contract’. We started hearing from patients who couldn’t get the treatment they needed, some who had to travel across the county to pay a lot of money privately, others being told by their practice to go privately, and some who have been waiting for many months without NHS treatment.
We first raised this with Kernow Clinical Commissioning Group in September, and have since had several written exchanges with them. The Health and Adult Social Care Scrutiny Committee at Cornwall Council expressed concerns in November, and local radio took up the case. We gathered patient stories, and last month there was quite a debate on the Specsavers Facebook page, with many people across the country unhappy that they are expected now to go to a private company and pay for treatment they have received at their local GP practice for decades. The latest we have from the CCG is that they will be reviewing all locally commissioned enhanced services, trying to identify unmet need, and will report back in six months’ time – meanwhile couched in language which describes the challenges of a finite workforce and a finite budget, saying that difficult decisions will have to be made. They consider that somehow excess earwax can be prevented rather than treated.
However, an estimated two million residents in the UK would question that opinion. For many people, earwax does not simply run out or dissolve, and clinical removal – whether by irrigation or microsuction – is required.
Our case is clear:
1) July 2019, NICE Quality Statement 1 in Hearing Loss in Adults:
Adults with earwax that is contributing to hearing loss or other symptoms, or preventing ear examination or ear canal impressions being taken, have earwax removed in primary care or community ear care services.
2) Kernow CCG is only commissioning a secondary care service for patients who meet very narrow criteria; and almost all the GP practices we know of are turning patients away, telling them to go to a private provider. Yet the terms from their Referral Management System are clear: “The lack of access to a service to remove routine ear wax in primary care is not an acceptable reason for referral to the Aural Care Service at RCHT. All such referrals will be returned.” Patients are trapped between a rock and a hard place, some unable to fund private treatment or the cost of travel to access it, others concerned that there is no guarantee of standards, safety, or any communication with the GP.
3) The Earwax leaflet from KCCG October 2020 tells us that "There are a number of local private providers who do offer ear wax removal to people who would like to use this service.” This makes it seem that ear wax removal is a matter of choice – those for whom excessive earwax causes hearing loss and other distressing symptoms don’t experience this as a preference but a necessity.
4) Prevention might help some, but the fact is that olive oil and bicarbonate of soda are used primarily as wax softeners to enable ear irrigation to be more successful. They do not of themselves remove excess earwax, which is a regularly reoccurring issue for many.
5) BMJ identified some years ago that just under a third of older people experience the problem of impacted earwax; and in the United Kingdom thousands of people every week need to have ear wax removed, with the chances of wax accumulation increasing if hearing aids are worn.
6) Southern Health NHS Foundation Trust have a very clear and comprehensive policy which is clear and sensible. This gives the statistics which might be of help to our KCCG, i.e. that over 2m people p.a. have problems with earwax and need it removed.
7) Devon Clinical Commissioning Group does include ear irrigation as part of the core primary care contract, so we question why Cornwall does not.
8) With hearing loss, patients may experience earache, itchiness or heaviness in the ear, reflex cough, dizziness, vertigo, or tinnitus, along with frustration, stress, social isolation, paranoia, depression, and particular challenges in communication for those living with dementia. Failure to remove impacted earwax in a timely manner causes very real problems for patients.
9) GPs should check a patient’s ears are clear of wax before referring them either to ENT (for infections or glue ear or tinnitus) or to Audiology (for hearing tests and hearing aids). This means that neither ENT nor Audiology can diagnose issues if patients have not been treated first at their GP surgery. Being required to pay privately before being referred is iniquitous and discriminatory and cannot be justified.
There is ample evidence, and growing disquiet, that failure to provide a service in our GP surgeries is causing difficulty to thousands of patients. It is vital that this service is restored without further delay, and without hiding behind COVID as an excuse.
If readers have stories to tell about their own earwax problems, or would like to join the growing campaign to reinstate ear irrigation/mcrosuction in GP practices, please get in touch with us:
West Cornwall HealthWatch
May 27th 2021