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In the UK around 12 million adults have some level of hearing loss, which is thought to increase dementia risk by up to five times, according to the Royal National Institute for Deaf People (RNID).
“There’s a growing body of evidence demonstrating the benefits of acting on hearing loss as early as possible, to reduce the risk of social isolation, mental health problems and dementia,” says Franki Oliver, audiology advisor at the RNID. “And yet we know people don’t take action soon enough.”
Yet, hearing loss is not the only ear problem faced by the public. There are over seven million adults living with tinnitus, while an ear infection is one of the most common reasons individuals seek a GP appointment.
Other ear complaints pharmacy teams may come across include balance problems, outer ear infection and impacted earwax. In fact, a survey conducted by manufacturer Earex found that two in five adults have suffered from earache with a third of these cases being due to impacted earwax.
“There is a lack of knowledge among consumers on how to manage earwax,” says Clare Campbell, brand manager at Earex. “Over half of those surveyed believed they neglect their ear health. Consumers tend to only seek help when things go wrong.”
As the first point of contact, pharmacy staff are well placed to help customers suffering from a variety of ear problems. Here we examine the most common conditions and the treatment options available.
Stuck in the middle
Otitis media, or middle ear infection, can often be caused by both a virus and bacteria. It is most common in children under four-years-old with symptoms including ear pain, dulled hearing and fever. Children may also be sick and feel generally unwell, while babies may be hot, irritable and unable to feed properly.
In many cases, middle ear infection will resolve itself within a few days, and pharmacy teams can recommend paracetamol or ibuprofen to relieve pain and fever. Most infections will not need antibiotics.
However, some customers should be referred to their GP, these include:
- Babies under three months with a fever over 38°C
- Babies aged three to six months with a fever over 39°C
- Anyone who is very unwell with the infection
- Children with recurrent ear infections as this can be a sign of glue ear, a condition where fluid builds up in the middle ear, eventually causing hearing loss.
Off-balance
Ménière’s disease is a long-term condition caused by a fluid build-up in the labyrinth, part of the inner ear responsible for controlling balance and hearing. It may be triggered by a variety of causes including autoimmunity, a genetic susceptibility, an imbalance of salt and potassium in inner ear fluid or a viral infection.
The condition can have a significant effect on an individual’s balance and hearing. Around one in 1,000 are affected and it’s most common in those aged 30-60. The main signs include unpredictable attacks of vertigo with nausea and vomiting, according to charity the Ménière’s Society.
Other common signs are tinnitus, hearing loss and a feeling of fullness in the affected ear. Attacks often last a few hours and can occur in clusters over several weeks. Although incurable, it is important to keep an eye on the condition as it can lead to falls and have negative psychological effects including provoking feelings of anxiety and depression.
A short course of prochlorperazine or an antihistamine can help relieve nausea during an attack. In severe cases, patients may need an intravenous injection of anti-nausea medication. Betahistine can also be prescribed to those 18 and over to reduce frequency and severity of attacks.
Keeping medication close to hand in case of sudden attacks should be advised. The Driver and Vehicle Licensing Agency (DVLA) should also be informed about the person’s condition, and they should stop driving when they are dizzy or if they experience a sudden bout of vertigo.
Lost in the labyrinth
Labyrinthitis is an inflammation of the labyrinth, usually affecting one ear. Mostly triggered by a viral infection, it causes dizziness, imbalance and hearing loss. The condition can affect all ages but is rare in children.
Customers with possible signs should see their GP for diagnosis. Anti-vertiginous medicines, antihistamines and rest are advised for a viral infection – acute episodes are usually improved after two weeks. Bacterial labyrinthitis is treated with antibiotics.
Those with the inflammation are advised to rest in a dark room when feeling dizzy, avoid noise and bright lights, get plenty of sleep and keep the eyes focused on a fixed object when walking.
Ringing out
Tinnitus is the sensation of hearing a sound without any external source. It can be perceived as ringing, hissing, buzzing, whooshing, whistling, or humming. It can be in one or both ears, either constant or intermittent.
Around 30 per cent of the population will experience it at some time, while 13 per cent live with the condition constantly, with those who suffer from hearing loss and other ear problems being particularly susceptible.
“It’s hard to pinpoint the exact cause, but it’s generally agreed that it results from some type of change to the person’s wellbeing. Common causes include hearing loss, exposure to loud noise, stress and anxiety, ear infections, wax build up, glue ear and Covid-19 infection,” says Nic Wray at the British Tinnitus Association (BTA). “Customers should be reassured that tinnitus is common and may resolve by itself and that there are a number of management options. An ear examination by a GP should be suggested to identify and treat any external ear problems. They can also make a referral to audiology services for further assessment.”
Nic explains that after initial assessment and tests, key management tactics include “treating any underlying condition, managing the hearing loss, using sound therapy and trying talking therapy, such as CBT”. In addition, “if a hearing aid has been prescribed, this should be worn as directed”.
For further support the BTA has a free e-learning programme called Take on Tinnitus which covers using hearing aids, sleep, relaxation and sound therapy. See: takeontinnitus.co.uk for more information. The BTA website also has a support team who can answer queries by phone (0800 018 0527), email, text or webchat. Posters and leaflets are available for pharmacy staff.
Sink or swim
Otitis externa (swimmer’s ear) is an inflammation of the external ear canal. The condition is classed as acute if it lasts less than six weeks and chronic if longer than three months – acute is usually due to a bacterial infection and chronic, a fungal infection.
Symptoms include itching in the ear canal, ear pain, discharge and sometimes hearing loss. There is often a lack of earwax in the ear canal and dry, scaly skin.
Swimming can make the ear canal more prone to infection, but other causes include dry skin conditions, otitis media and trauma to the ear canal from cleaning, syringing, ear plugs or hearing aids.
There are a variety of treatment options available for customers suffering from swimmer’s ear, including:
- Acetic acid 2% drops or spray for a maximum of seven days
- Analgesics to manage pain
- Topical antibiotics can be prescribed, along with a topical corticosteroid
- For chronic infection caused by fungal infection, a topical antifungal such as clotrimazole can be prescribed.
Self care tips to share with customers include keeping the ears clean and dry; avoiding swimming for at least seven to 10 days during treatment; wearing ear plugs and/or a tight swimming cap; and keeping shampoo, soap and water out of ears when showering. Using a hair dryer to dry ear canal after hair washing, showering or swimming can also help.
Keep the door open
Aside from offering treatment advice for ear conditions, pharmacy teams can also work on making the pharmacy more accessible, particularly for those suffering from hearing loss. Though this may seem like a difficut task, there are plenty of simple ways to make a difference.
“Make sure you have accessible contact methods, so that deaf customers or those with hearing loss can contact you. This includes offering an email or text option on your website for people to contact you through Relay UK or video relay services for BSL users,” says Franki. “If you wear face coverings, be aware that someone with hearing loss won’t be able to lipread you. Consider taking your face covering down or using one with a clear panel.”
OTC Category Reviews
In OTC Category Reviews
Follow month by month updates on topics including asthma, mental health and skin conditions and be able to provide informed advice to customers at the counter.