Ear wax removal and core services in general practice

Abstract Aim The COVID-19 pandemic has resulted in initial GP consultations being conducted via telephone. This quality improvement initiative quantified this impact on ENT referrals conducted at a West London GP, using education to improve awareness of the relevant NICE guidance to reduce inappropriate referrals. Method An initial retrospective audit comparing number and urgency of ENT referrals and the appropriateness of ENT referrals (using NICE guidance) during the face to face (F2F) period (August 2019 – February 2020) and telephone period (March – September 2020) was performed. Results were presented locally to GPs, with education measures on relevant NICE guidance implemented. Further PDSA cycles occurred during October and November 2020. Results In total, 16 ENT referrals were made during the F2F period (routine n = 15; urgent n = 1); 3 were inappropriate. 31 referrals were made between March and September 2020 (routine n = 27, urgent n = 2, 2WW n = 2); 4 were inappropriate. Further cycles in October 2020, and November 2020 identified 13 referrals (routine n = 10, 2WW n = 3), and 2 referrals (routine n = 2) respectively. 1 inappropriate referral was made during October and none in November. Conclusions Locally, it appears that the number of routine referrals has increased since the advent of the initial lockdown. This may be partially explained by the practice losing the ability to perform some ENT services, such as ear wax micro-suctioning. Education to increase awareness of relevant guidance has been shown to reduce the number of inappropriate referrals to ENT services.

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Effectiveness of Same-Day Human Ear Wax Removal as an Office Procedure and Factors Associated with its Successful Removal

Journal of Lumbini Medical College ◽

10.22502/jlmc.v5i2.148 ◽

2017 ◽

Vol 5 (2) ◽

pp. 45-48

Author(s):

Anup Acharya ◽

Bhuwan Raj Pandey ◽

Madan Mohan Singh ◽

Shiva Bhushan Pandit

Keyword(s):

Office Procedure ◽

Complete Obstruction ◽

Factors Associated ◽

Ear Wax ◽

Secondary Objective ◽

Successful Removal ◽

Human Ear ◽

Ear Drops ◽

Wax Removal

Introduction: There are various methods of ear wax extraction and there are no specific guidelines on this subject. Many times we ask patients to instil some wax softening product for a few days and revisit for wax removal. This revisits result in increased cost, discomfort and loss of time. We conducted this study to determine the effectiveness of same-day ear wax removal as an office procedure with one or more techniques. Our secondary objective was to find the association between various factors and successful wax removal. Methods: During the study period, all patients with ear wax managed by a single ENT surgeon were included. History and examination were done and findings noted. One or more methods including probe, forceps, hooks, curette, suction, wax softening with wax softening agents, syringing were applied for wax removal. Complete wax removal was noted as success. Results: There were a total of 63 cases of ear wax among 34 participants. Wax was successfully removed in 52 (82.5%) cases in the same day. Presence of ear ache, narrow canal, complete obstruction and hard dry wax were adversely associated with successful wax removal. Presence of ear fullness, ear discharge, or use of ear drops in home was not significantly associated with successful ear wax removal. Conclusion: We were able to extract wax from a large proportion of patients on the same day of visit, thereby reducing their cost of revisit, however there were 17.5% of cases who could not be treated successfully on the same day.

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