Prior to starting the assessment, your Ear Care Practitioner (ECP) will discuss the aims and benefits of otoscopy, ear wax removal and hearing assessment. In order to check that it is safe to proceed you will be asked some questions about your ears and general health. It will also be necessary to carry out a detailed digital visual examination (otoscopy) of your ear(s) and confirm that wax is present. If safe to do so and clinically necessary, wax will be removed from your ear(s) using the most appropriate method according to the quantity and consistency of the wax discovered. Please note it is common for your consent to be taken by the Ear Care Practitioner (ECP). This practitioner will be suitably trained and competent to take consent and to perform the procedure. You may have questions before starting, during or after your procedure. Please discuss any concerns about your treatment with your ECP. The risks quoted in this Patient Information Sheet assume that you have no additional factors, which would increase your risk.

The Ear Care Practitioner (ECP) will ask for your permission to examine your ear(s) using the digital video otoscope called the Endoscope I device. This allows examination of the ear canal and eardrum. The assessment involves you sitting comfortably whilst allowing the ECP to gently insert the digital otoscope into your ear. The ECP will then explain what they see during the assessment. Depending on what is found, a further review with a GP, Audiologist or an Ear, Nose and Throat Specialist may be required.

These include:

1. Ear wax or foreign body that might be blocking the ear

2. Discharge – fluid coming out of the ear

3. Bulging eardrum – indicating that there is infected fluid in the middle ear

4. Dull eardrum – indicating uninfected fluid in the middle ear (glue ear)

5. Retracted eardrum – indicating that the Eustachian tube is not working properly

6. Perforated eardrum – a hole in the eardrum, with or without signs of infection

Common (Might happen (more than 1 in 20)

• Mild discomfort when the otoscope is introduced / removed from the ear

Rare (Probably won’t happen (fewer than 1 in 100)

• Severe pain

• Trauma to the ear canal

You may be advised to soften the wax with olive oil prior to your appointment. Your ear(s) may feel blocked following application of an ear wax softener due to the expansion of the wax. If you are a hearing aid wearer it can be advisable to avoid wearing the hearing instrument/s when olive oil has recently been administered, therefore overnight application of an ear wax softener may be best. If you have a hole in your eardrum (current or previously) then do not use sodium bicarbonate based eardrops to soften the wax.

Two methods of wax removal may be used during your appointment, micro suction and/or manual removal.

Removal of wax using manual extraction instruments

 Fine hand-held instruments are introduced carefully into your ear and used to gently remove the wax from the ear canal. These will not be used when the wax is deeply situated in the ear canal.

Wax removal using micro suction

Wax is removed from the ear by a small suction tube which can be noisy

Your ECP has undertaken training and is certified as competent in ear care and wax removal and will use best practice procedures to minimise any risk. However, even when performed with the utmost care, there are some risks involved in wax removal. These risks include:

 Common (Might happen, more than 1 in 20) 1.

• Wax removal cannot be completed

Uncommon (Unlikely to happen, fewer than 1 in 20)

• Discomfort / pain (minimised by application of olive oil prior to appointment)

•  Damage to skin of the ear canal (minimised by application of olive oil prior to appointment)

•  Bleeding from ear canal (abrasion or bruising)

• Ear infection (minimised by water precautions post procedure)

•  Temporary reduction in hearing

•  Temporary hearing sensitivity

• Temporary worsening of existing tinnitus

• Temporary irritation to the throat or stimulation of cough

Rare (Probably won’t happen, fewer than 1 in 100)

• Damage to the ear drum during the procedure (minimised by restricting the depth of insertion of the suction tube)

•  Feeling Lightheaded

•  Temporary dizziness

Extremely rare (Probably won’t happen, fewer than 1 in 1000)

• Permanent hearing loss (minimised by limiting time of exposure to noise of suction machine and avoiding any contact with or trauma to the ear drum)

• Permanent new tinnitus (minimised by limiting time exposure to noise of suction machine)

• Fainting during or shortly after the procedure

If the wax cannot be removed

Depending on the amount and consistency of the wax and your own comfort, it may not be possible to remove all of the wax in a single appointment. A second or third appointment may be required with further softening of the wax for a few days between visits using alternative softeners as advised.

Onward referral

 In some situations, wax removal may be deemed unsuitable or need to be abandoned during the procedure due to safety reasons. This is due to identified abnormalities of the ear which require further assessment by your GP or an ENT specialist, and hence making it inappropriate to proceed.

It may be necessary to refer you following the procedure for a follow up with a medical professional either directly (or via the “Clearer care Panel” remote review system) for further management, advice, or a second opinion.

Most commonly this is because

1. Evidence of current or recent infection has been discovered

2. Evidence of current or previous damage to the ear has been discovered

3. Wax removal procedure has made you feel unwell

 4. Wax has proven to be too difficult to remove safely or without causing discomfort

5. Foreign body has been discovered in the ear which cannot be removed safely

 Before, during and after the procedure your clinician will record images and videos within your ear(s). This media may be used for the following reasons:

1. To request further advice or a second opinion from another suitably qualified medical professional

2. Training, Education and Research

 3. To ensure you, the patient, are as informed as possible

Keep ears dry for a minimum of 24 hours after the appointment. It can be helpful to use a cotton wool ball in the entrance to the ear canal with some petroleum jelly when showering. Inform your clinician and seek advice from an appropriately qualified medical professional immediately if any discomfort, pain, swelling, discharge, odour or disruption to your hearing is experienced following the procedure.