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Earwax Removal - Is It Time For Regulation?

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Earwax Removal - Is it time for regulation?

I’m writing this in response to a number concerns I have about many aspects of earwax removal and the way in which it could affect patient safety. The aims of the article are to raise awareness and promote debate. 

Patients need to be aware of who they are seeing, their training, competency and clinical expertise should all be questioned.

The wax removal industry needs to ask itself, are we providing patients with a robust and safe process that users can enter without fear of harm or damage.


If you feel that your ears are blocked with wax, you realise that you need to get them cleared so that you can hear properly and communicate effectively. You decide to book an appointment.

STOP

Just take a minute and ask yourself, actually is this person qualified to take care of my ears and competent to safely remove the blockage?

Firstly, I will call the individual carrying out the procedure the ‘Earwax Remover’ for the purposes of this blog. They could be a registered audiologist, registered nurse, registered healthcare worker, registered medic or someone who isn’t registered or have any relevant medical experience whatsoever. 

We need to look at the whole process so that the patient has all the information to try and make an informed decision.

Are the people training the Earwax Removers qualified to deliver the training courses?

There are a number of training providers who can deliver appropriate courses and sign off on the competency of Earwax Removers. These courses are excellent and definitely fit for purpose.

However, there are wax removal courses being run by individuals who appear not to have any relevant experience or qualifications in the procedures required and who do not perform regular earwax removal themselves. It would appear that they have assumed a position of having the knowledge to deliver courses. There are audiologists who have undertaken these courses and feel  ill equipped and unprepared to remove earwax following their ‘training’ , this is a wholly unsatisfactory outcome. 

If your Earwax Remover has been fully trained and their competency to practice been verified then you are more likely to be cared for appropriately. They have been trained correctly. 

If the Earwax Remover has attended an unaccredited course, then beware, take a moment and think, should I trust this person to treat me.

Is it time the industry regulated the people providing wax removal training and verify that the courses being provided are fit for purpose?

 

Have the relevant professional background checks been made prior to the person attending the course?

There are some supposed training courses that do not check if the person attending their course is even a healthcare professional, in effect they will let anyone attend the course regardless of their previous experience, as long as they pay the course fee. This is certainly not a safe way to vet people undertaking the training.

Should we have a list of appropriate occupations that have transferrable skills that would be suitable to undertake the training in the first place?

 

Which professions should be allowed to remove earwax?

I’m all for the patient having freedom of choice and being able to go to an Earwax Remover that can see them at a time that suits them. However, there seems to be no boundaries as to which healthcare professionals can offer earwax removal. I heard  recently that Pharmacists were going to be trained in the removal of earwax.

I have the upmost respect for Pharmacists and the professional expertise that they dispense to their patients on a daily basis. They are highly respected healthcare professionals. 

I would ask, what clinical expertise does a Pharmacist have in delivering physical hands on treatments to patients? It’s not what they were trained to do and it’s not their area of expertise. It makes no sense.

Surely, it is in the best interests of the patients to see healthcare professionals who are experts in their field, who can advise appropriately and make recommendations.

As a Clinical Audiologist I advise patients on hearing related difficulties. If my patient has a headache, I wouldn’t tell them to take a pain killer and assure them that everything will be fine. That’s not my area of expertise. I would ask them to see their GP or Pharmacist to discuss their symptoms so that they could use their expertise to help.

The old adage, ‘using the right tools for the right job’ springs to mind, you wouldn’t call the plumber if the electric sockets kept fusing. Seeing the appropriate professional to deal with the specific problem is the way to go.

Should anyone who works in healthcare be allowed to remove earwax?

 

Which wax removal methods are covered on the training courses?

Generally, these courses tend to focus on a single technique of wax removal. These techniques are micro suction removal, irrigation (the use of water)  and manual removal ( the use of specialist instruments). Earwax removal can be carried out using one technique, however there are some complex removals that require a combination of all three techniques. Many Earwax Removers only employ the micro suction technique as they only have training in that particular method. Those who are trained in all three techniques are better equipped to clear your ears the safest way depending on what they see. The appropriate technique is used for the specific type of blockage.

 

Should Earwax Removers display on their websites and in their office the removal methods they have been accredited to use?

 

What equipment is the Earwax Remover using?

As with everything you can pay a little or a lot for your equipment to carry out wax removal procedures. One of the most important items being the equipment you will be using to visualising the wax as you are removing it. Let’s face it, the Earwax Remover is carrying out delicate and precise movement deep inside a small and shallow ear cavity. They need to be able to see clearly and accurately, it’s paramount to the patients safety.

There are some excellent products available to view inside the ear to ensure the view is clear, accurate and safe, I would suggest that this loupe model below is not one of them, however, there are earwax removers out there using these.

 

However, these, whose cost is in the region £1700 are bespoke viewing loupes designed to suit the individual with custom lens seperation and working distance. They are made to measure. These are also used by Dentists also when they are carrying out delicate work.

Large microscopes are also utilised, which also give a very clear and accurate view inside the ear canal.

It is also important that the instruments used for suction are of high quality. We’ve experience of trying Zoellner tubes from some manufacturers and finding that the metal tip has come apart from the plastic handle, not exactly what you want to happen if it’s inside a patients ear.

 

Should the equipment being used have to pass certain standards and then be included on a list of approved equipment?

 

What premises are being used for earwax removal?

I certainly expect the majority of people to be seen in a clinical premises, where they would have all the facilities required to ensure cleanliness is of the highest order. There will be occasions when the patient is unable to travel and needs to be seen in their own home, this should be the exception rather than the rule.

This is not always the case, last month I heard about somebody who visited a residential premises in a block of flats to have their earwax removed. 

Should the premises where wax removal is carried out be subject to inspection?

 

How should patients proceed?

It’s a difficult proposition that patients face, where do they go and who do they trust? In the absence of any regulation, verified accreditation or industry standards their choice can become a leap of faith.

 

Should the removal of earwax be regulated?

First and foremost the safety and care of patients requiring earwax removal is paramount, there should be no need for discussion about this.

Following on from this they should expect Earwax Removers to have achieved a minimum acceptable accredited standard verified by accredited course providers. They should expect the equipment used is of a minimum standard not the least expensive products that can be purchased through Ebay. They should expect a suitably skilled healthcare professional delivers the service.

I know for many people that rules and regulations can be the bane of their lives but the earwax removal industry needs to look at itself and ask some pertinent questions before something serious happens. 

Can we provide a safer environment, where we know that every provider has been diligently accredited in all aspects of their service provision? 

It’s what every patient deserves.

 

Peter Jones - Clinical Audiologist