Ear health professionals are worried that earwax removal services are being provided to members of the public by untrained individuals, according to a new survey.
Audiologists expressed worries over the lack of standardised training and suboptimal access to these services, without which there is a risk to patient safety.
“We need wax removal to be brought back within primary care and free for audiology patients to access,” said a respondent to the 2024/2025 Audiologist Survey, organised by the British and Irish Hearing Instrument Manufacturers Association (BIHIMA).
The annual survey is designed to gather insights from audiologists across the UK, prompting discussion on the prevalent issues affecting hearing care delivery and identifying opportunities for improvement.
Lack of standardised training in ear cleaning
The call for reform includes substantial criticism of current training practices which allow individuals with minimal audiology experience to operate as earwax removal specialists after completing only a short course.
This has raised alarm among professionals regarding the potential miscommunication of expertise to patients and the consequent risk of bad outcomes.
Patients treated by unqualified practitioners have been known to suffer from bleeding, tinnitus, hearing loss, perforation or infection.
“All our practitioners have the relevant qualifications and registration and we’ve also gone the extra step of seeking and obtaining Care Quality Commission regulation, which we are not obliged to do,” said Laurence Coen, co-founder at Hearology®, an independent audiologist with clinics in central London and the south east of England. “All registered audiologists across the country have had the necessary training to carry out ear wax removal correctly and safely.
However, there are now thousands of individuals who are not trained audiologists or nurses who are performing audiological procedures, particularly ear cleaning, in locations that don't meet even the most rudimentary clinical requirements and standards of hygiene. These individuals also lack the necessary qualifications, training, and experience - and they are using only the most basic equipment. This number, unfortunately, includes many physiotherapists and pharmacists who see ear cleaning as a potentially lucrative sideline.”
Patient safety concerns and complications
“We see more and more new clients at Hearology®,” Coen continued, “who ask us to clean up the mess created by the cheapest ear wax removal service provider they could find. Removing earwax painlessly not only requires a level of dexterity that few have, but there’s so much more to this practice than just removing wax.
For example, being able to spot non-trivial complications, such as a cholesteatoma, otitis media or otitis externa. Or being able to deal with keratosis obturans or a mastoid cavity. And what if there’s no wax to remove, but the patient is reporting a perceived blockage - what do these unregulated and poorly trained providers do then?
They offer you a discount and send you on your way, because they have no idea what to do next! So you end up having to go to a proper audiologist in the end anyway - at which point, you’ve paid twice. It’s a very frustrating situation for both the general public and authorised providers such as ourselves, and it’s very difficult to know what to do about it.”
Challenges in NHS audiology and staffing shortages
In addition to concerns regarding earwax removal, the survey revealed that long NHS waiting lists are affecting both public and private hearing care services.
Patients face a median waiting time of 14.5 weeks before receiving audiology services. “Waiting times are problematic, especially regarding referrals for further investigation of asymmetrical hearing losses and conductive issues,” a survey respondent remarked.
Staffing shortages and low morale within the profession have emerged as further pressing issues. NHS audiologists reported being overwhelmed with increasing workloads, coupled with reduced appointment times.
One professional commented on the negative impact of management pressures to lower waiting lists. “We are losing staff frequently to the private sector, which then puts more pressure on the service,” they added, highlighting the difficulties in retaining skilled professionals in the field.
Regular ear health checks are important to identify physical issues that could lead to hearing loss, which can be exacerbated by various factors such as lifestyle choices and environmental influences.
The role of earwax, which varies in properties across different populations, is also crucial; it not only protects the ear canal but also contributes to overall ear health when properly managed.
Safe earwax removal techniques, such as microsuction, have gained recognition over traditional methods, providing effective ways to clear the ear without the associated risks of syringing. This shift highlights the importance of consulting regulated hearing professionals for regular check-ups to mitigate the risks associated with improper earwax removal.
The findings from this BIHIMA survey provide important insights into the current state of hearing care, where earwax management, waiting times, and staffing issues pose significant challenges that, unfortunately, don’t look like they are going away anytime soon.
References
- Audiologist survey highlights the need for industry change - Highlights the challenges in the audiology industry, including staffing shortages and the impact of the cost-of-living crisis on hearing device affordability.
- BIHIMA UK Audiologist Research Panel Results - Provides information on BIHIMA's research panel results, which include insights into the challenges faced by audiologists, such as patient awareness of hearing loss and cognitive decline.
- NHS Hearing Loss conditions - Provides general information on hearing loss, which is relevant to the broader context of audiology services and challenges discussed in the article.
- The British Society of Hearing Aid Audiologists - Provides insights into the professional standards and practices within the audiology sector.
- What does the UK's 2024 Audiologist Survey Report reveal? - Discusses the BIHIMA 2024 survey and its focus on gathering insights from audiologists in the UK, highlighting challenges in hearing care delivery.
