Reviewed on : 24 Sep 2025

Reviewed by : Lucy Dyde, IFR Team Manager

Expires : 24 Sep 2027

1. Category: Prior Approval

Prior approval from the Integrated Care Board (ICB) will be required before any treatment proceeds in community services and/or secondary care unless an alternative contract arrangement has been agreed with the ICB that does not necessitate the requirement of prior approval before treatment

2. Background

Ear Wax Removal in community services and/or secondary care (for all ages) is not routinely funded by the ICB and is subject to this restricted policy

Ear wax is completely normal and healthy

If wax builds up, most people can clear existing wax and prevent future wax build up through self-management

Build up of ear wax, even if this results in some symptoms or hearing loss, should usually be managed by drops/self care

Patients presenting with problems to primary care will be managed in Primary Care with advice or ear irrigation (syringing) in line with Earwax | Health topics A to Z | CKS |NICE

Occasionally, it may be inappropriate to treat patients in primary care, or such treatment may be ineffective

These patients may therefore seek to access Microsuction of the ear canal via the community service or in secondary care

3. Indication

Ear Microsuction is a key service for the following patient cohorts:

• Patients who have undergone modified radical mastoidectomy (mastoid cavities) or other ear surgery requiring regular aural care
• Patients who require aural care for chronic or recurrent ear pathologies
• Patients with a foreign body in ear canal
• Patients with any other acute condition for which microsuction may be required
• Patients who require removal of ear wax to allow visualisation of the tympanic membrane for the purposes of diagnosis or provide treatment
• Patients who are unable to self-manage and where treatment in Primary Care is not appropriate such as people with learning difficulties or cognitive impairment such as dementia

4. Eligibility Criteria

Referral to Community Services:

• Patients who have undergone modified radical mastoidectomy (mastoid cavities) or other ear surgery requiring regular aural care OR/AND
• Patients who require aural care for chronic or recurrent ear pathologies OR/AND
• Patients who require removal of ear wax to allow visualisation of the tympanic membrane for the purposes of diagnosis or treatment OR/AND
• Substantial hearing loss due to earwax OR/AND
• Substantial tinnitus symptoms thought to be due to ear wax OR/AND
• To allow accurate assessment and fitting of a hearing aid

Referral to Secondary Care Services:

Where there is a foreign body in ear canal

Patients with any other acute condition for which microsuction may be required

Discharge from the ear

For patients who DO NOT meet the eligibility criteria, the ICB will only consider funding the treatment if an Individual Funding Request (IFR) detailing the patient’s clinical presentation is submitted to the ICB

5. Guidance/References

Earwax build-up – NHS

Earwax | Health topics A to Z | CKS | NICE

NICE NG98: Hearing loss in adults: assessment and management

NHS England: ENT Community Frameworks for Adult Earwax, Hearing Loss and Tinnitus MIDS ENT01 July 2024