Average appointment waiting times for GPs are increasing and some surgeries no longer provide non-essential services, such as ear wax removal. Customers are therefore likely to turn to pharmacies for advice on ear problems such as excess wax and swimmer’s ear, so knowing what to ask and when to refer customers to a GP is key.

Earex brand manager Clare Campbell suggests pharmacies stock a wide range of products that target different ear issues. “Good category management and an in-depth knowledge of the products available will help pharmacy staff to efficiently advise consumers on the best ear care treatments available to them,” she says. 

Earex is supporting seasonal demand by launching a PR campaign in spring 2020 that aims to educate consumers about hearing (‘the neglected sense’), the benefits of product use, the importance of self care and general ear health misconceptions. In addition, Earex offers a range of POS materials that enable pharmacies to promote products correctly and create awareness.

Common ear complaints

Otitis media

Acute otitis media, or middle ear inflammation, is most common in young children. A discharge is often present and there is usually a rapid onset of symptoms. Otitis media can also accompany a cold. Pain can be treated with appropriate OTC analgesics but customers should see a GP if the infection doesn’t resolve itself or symptoms are severe.

Symptoms of an ear infection usually include: 

• Pain inside the ear or earache
• An increased temperature of 38C or above
• Being sick
• Lack of energy
• Discharge running from the ear
• A feeling of pressure or fullness inside the ear
• Itching and irritation in and around the ear
• Scaly skin in and around the ear.

Otitis externa (swimmer’s ear)

Otitis externa is inflammation of the outer ear canal. It’s often called swimmer’s ear because repeated exposure to water can strip the ear canal of natural protection, leaving it vulnerable to infection. Symptoms include pain, tenderness around the jaw or when the outer ear is pulled or pressed, discharge, itching and some hearing loss. OTC remedies containing acetic acid are available, but if symptoms last longer than a few days or are severe, the customer should be referred to a GP as an antibiotic may be required. According to NICE, otitis externa can be prevented by:

• Removing ear wax safely – not with cotton buds or other objects
• Keeping ears clean and dry while swimming
• Using acidifying ear drops or sprays before and after swimming.

Tinnitus

According to the British Tinnitus Association, about one in three people will experience tinnitus at some point, with 10 per cent of sufferers reporting an impact on quality of life, sleep, mood, concentration, employment and even relationships. There are about 1.05 million GP consultations for tinnitus in the UK each year, costing the NHS in the region of £750 million, and the number of people with tinnitus in the UK is on the rise.

Symptoms include hearing noises in one or both ears. This is usually more noticeable at night and in quiet environments. Tinnitus can be caused by a heavy cold or impacted ear wax, persistent exposure to loud noise or a blow to the head. Steps that can be taken to prevent and/or treat it include:

• Leaving any source of noise that hurts the ears
• Using appropriate ear protection and reporting excessive noise to employers if it’s work-related. They are legally obliged to act if noise levels exceed 80dB
• Giving ears a break from constant in-ear music and using a volume limiter on phones and gadgets.

Pharmacy staff can also offer advice on noise protection such as earplugs, earmuffs and canal caps.

Where ear wax build-up is the issue, products such as Earex Advance, Cerumol or AudiClean ear wax remover may help. 

What to look out for

“If possible, the first step is to identify whether the symptoms are attributed to wax occlusion or a more serious infection,” says Karen Finch, audiologist and managing director of The Hearing Care Centre. “If there is a wax blockage, then the patient should seek professional ear care either via their GP or a private qualified clinical ear care service. However, many GP surgeries across the country do not offer this service.”

The symptoms of a wax blockage include:

• Earache
• Occluded sensation or feeling of fullness in the ear
• Decreased hearing
• Ringing in the ear (tinnitus) 
• Dizziness.

“There are a variety of self-cleaning implements available that make claims about how easy it is to clean one’s own ears,” says Ms Finch. “But the simple truth is that you cannot see inside your own ears and are unlikely to be aware of possible complications, such as perforated or weak ear drums. The ear is a delicate, well-balanced structure that can easily be damaged.”

She suggests that a qualified ear care practitioner will be able to help if a GP cannot. “They will be trained not only to facilitate the safe and comfortable removal of ear wax using a variety of different methods, including microsuction, but they are equally trained to recognise diseases and unusual features of the ear,” she says. “They know when to onward refer to specialist medical practitioners.

“The use of video otoscopy is invaluable for ear care and seeing for yourself the condition before and after the procedure gives the client confidence that the removal procedure has been effective.”

The potential symptoms of problematic ear wax depend on the individual and the severity of the case, according to experts at Cerumol. Many people are unaware of the causes of ear wax build-up, so pharmacy teams are well placed to advise customers who are buying products designed to clear it. “A range of genetic factors can increase the likelihood of problematic ear wax, including narrow or deformed ear canals, excessive ear hair, ageing and a history of recurrent ear infections and impacted ear wax,” says the brand. “In addition, issues are often caused by external instruments such as hearing aids and earplugs, which push the wax further in.”

One key piece of advice for pharmacists to pass on is never to clean the delicate ear canal area with cotton buds. This is often counterproductive because it can push built-up wax further into the ear canal and can cause long-term damage to the eardrum and canal. 

The most prominent warning symptoms that should trigger a medical referral include sudden deafness, which may indicate a perforated eardrum, bleeding from the ear, significant pain, ear discharge (especially if offensive smelling) and swelling behind or around the ear, says GP and Earex expert, Dr Roger Henderson. “For more common problems, such as ear irritation, ear wax or dry skin, then ear drops are the first recommendation,” he says.

Some complementary health practitioners offer ear candling as a solution for ear wax build-up. NICE does not recommend the procedure. It says ear candling has no benefit in the management of ear wax removal and may result in serious injury.