Ear wax

Prescribing Notes:

• To soften ear wax the oil should be warmed to room temperature and a generous amount introduced into the affected ear. The patient should lie with the affected ear uppermost for 5-10 minutes. The treatment should preferably be given for 3-4 days before irrigation to ensure maximum softening of the wax.
• Olive oil is a suitable alternative to almond oil, especially in those with nut allergies.
• Some proprietary products (e.g. Cerumol, Otex) contain organic solvents which may irritate the meatal skin. These products are considered less suitable for prescribing by the BNF and should not be prescribed. Almond oil or olive oil is just as effective, less expensive and less likely to cause irritation.
• Wax need only be removed if it causes hearing loss or interferes with a proper view of the ear drum.
• Ear wax may be removed by irrigation with warm water.

Prescribing Notes:

• Ear wax needs to be removed only if it causes symptoms of discomfort or hearing loss.
• Due to evidence being limited as to effectiveness of treatments, advise patients to try olive oil.
• The ear is a self-cleaning system and cotton buds should not be used to try to clear the ear canal, as wax is likely to be pushed back against the ear drum and become more impacted.
• After instilling the ear drops, the person should lie with the affected ear uppermost for 5-10 minutes.
• Sodium bicarbonate ear drops may cause dryness of the ear canal.
• Some proprietary products (e.g. Cerumol, Otex) contain organic solvents which may irritate the meatal skin. These products are considered less suitable for prescribing by the BNF and should not be prescribed. Almond oil or olive oil is just as effective, less expensive and less likely to cause irritation.

Examples of Counselling Points
The patient should lie with the affected ear uppermost for 5-10 minutes after a generous amount of the softening remedy has been introduced.

When to advise patient to contact GP
Otitis media in the last 6 weeks.
History of ear drum perforation.
Severe ear pain or pain lasting for more than 2 days.