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Currently one in six people in the UK are affected by hearing loss, with around 900,000 being classed as clinically deaf.
In fact, there are more people living in the UK with hearing loss than diabetes, coronary heart disease and cancer combined, according to hearing clinic, Hear4U. Hearing loss, however, is not the only way ears can be affected. Many people experience issues with their ears from time to time – from a build-up of earwax to tinnitus or infections. Most ear problems clear up quickly with the right treatment and are unlikely to lead to any long-term problems. However, they can cause a lot of discomfort, affect hearing and – if they involve the inner ear – cause vertigo so customers will need to deal with any symptoms quickly and effectively.
Community pharmacy is often the first port of call for ear health advice, so it’s vital that the whole pharmacy team knows how to help. While some acute symptoms, such as sudden or severe hearing loss, require a GP appointment, others may be treated over-the-counter.
Earwax build-up
Although earwax (cerumen) serves to keep the outer ear clean and protects it from damage, it sometimes builds up and blocks the ear canal. This can occur at any age but is most likely to affect older people and those wearing hearing aids or using earbud earphones. In November 2022, many people reported symptoms that can be associated with earwax blockage, such as hearing loss, tinnitus, earache and dizziness, according to the Royal National Institute for Deaf People (RNID). Some also reported that these symptoms affect their overall wellbeing, including their mental health.
“General advice says to leave earwax alone,” explains Nic Wray, communications manager at Tinnitus UK. “However, earwax build-up can affect how well hearing aids work, and for some people can trigger tinnitus. If earwax build up is bothersome, it should be treated. Cotton buds or other items shouldn’t be inserted into the ears, but earwax-softening drops or olive oil should be considered as the first option.”
Medical grade olive oil ear drops can be used three to four time a day for three to five days to reduce earwax build-up as well as earwax removing drops or sprays. These soften the impacted wax so that it then falls out naturally.
Self-management isn’t always sufficient on its own, however, and people with hearing loss, earache, tinnitus, itchy ears or vertigo may need to have their earwax removed. “While in many cases, earwax can be safely and effectively removed at home using over-the-counter ear drops or by gently flushing the ear with warm water, in some instances it’s best to call in the professional,” says Rob Ormerod, audiology director at Bayfields Opticians and Audiologists. “There are a number of techniques your healthcare professional will use, including micro-suction for the safest wax removal.”
About 2.3 million people each year in the UK have troublesome earwax requiring removal, according to research published in January 2023 by University of Manchester audiologists in the British Journal of General Practice. The researchers found that hearing difficulty was the most common and troubling symptom of blocked ears – after the earwax had been removed, more than eight out of 10 people noticed an immediate improvement.
Outer ear infections
Otitis externa causes inflammation and infections of the outer ear canal. This can trigger ear pain, a watery discharge and temporary hearing loss. Otitis externa may be caused by a bacterial or fungal infection, a skin condition such as eczema or psoriasis, or an allergy (e.g., to hair products). It may also be triggered by swimming, sweating or being in a humid environment. Using cotton buds to dry or clean out the inside of the ear, or scratching inside the ear, increases the risk.
Acidic eardrops are available over-the-counter from pharmacies. These will help to stop any bacterial or fungal infection from spreading. If the symptoms persist, customers should contact their GP who may prescribe stronger medicated ear drops (often containing a corticosteroid), or antibiotics for a severe infection. To prevent swimmer’s ear, customers should be advised to wear earplugs designed for swimming and bathing to stop water getting into the ears. With treatment, otitis externa should clear up within two or three days.
Middle ear infections
Otitis media (an infection in the middle part of the ear) is most common in young children but can affect all age groups. It generally occurs when a bacterial or viral infection spreads from the nose or throat into the ear. The infection leads to a build-up of fluid inside the ear, which can lead to earache and slight hearing loss. In severe cases, the eardrum can tear, with a sudden discharge of pus and blood into the outer ear canal.
Most middle ear infections clear up within a few days to a week without any specific treatment. Taking painkillers, such as paracetamol or ibuprofen, and placing a cold or warm flannel against the ear may help to ease any pain. If there’s no improvement after three days, or the patient is very ill, a GP may prescribe eardrops containing a painkiller and anaesthetic. Antibiotics aren’t usually needed for a middle ear infection, but these may be prescribed if the symptoms are severe.
Glue ear
Usually, excess fluid inside the middle ear drains away down the narrow Eustachian tube, which runs from the middle ear to the back of the throat. But sometimes sticky fluid builds up, leading to glue ear. Glue ear may develop after a middle ear infection. Other possible causes include colds and flu, allergies and passive smoking.
Glue ear generally causes temporary hearing loss, affecting one or both ears, along with earache or tinnitus. It may also affect balance. In children, possible signs of glue ear include speaking more loudly or quietly than usual, seeming tired and irritable, and asking for the TV or music to be turned up. If glue ear lasts for a long time, it can affect a child’s speech development and progress at school.
A GP can diagnose glue ear by looking for fluid inside the ear. They may decide not to treat it, as glue ear usually clears up on its own after around three months. However, antibiotics may be prescribed if the glue ear is causing infections.
While waiting for the glue ear to clear up naturally, a GP may suggest trying a treatment called auto inflation, which helps the fluid to drain away. Auto inflation involves either blowing up a special balloon using one nostril at a time or swallowing while holding the nostrils closed. This needs to be performed several times a day so it’s not usually recommended for children under three years.
If the glue ear doesn’t improve, a GP may refer a patient to an ears, nose and throat (ENT) surgeon, who may suggest inserting tiny ventilation tubes (grommets) temporarily into the eardrum. This enables air to circulate so that the fluid can drain away.
Tinnitus
According to the RNID, around one in seven UK adults has tinnitus. Some people experience tinnitus if they have a build-up of earwax or fluid in their ears. It’s often a temporary problem that clears up once the earwax or fluid is removed.
“We recently conducted research which reveals that over 37.1 million people in the UK (55 per cent) have experienced constant noise in the ears, such as ringing, roaring, buzzing, hissing, whistling or humming – which is most common symptom of tinnitus,” says Rob. “Tinnitus is described as any noise you can hear that’s not in the environment, and it’s different for everybody. While some sufferers may experience a ringing, others may hear a static or whooshing sound, buzzing or in some instances even music.”
Prolonged exposure to loud sounds is the most common cause of tinnitus – accounting for up to 90 per cent of cases. “Simply turning down the volume on everyday activities can have a very real impact on our ear health,” explains Rob. “Limit the length of time you’re exposed to loud sounds and invest in hearing protection devices such as ear plugs and ear defenders and keep on your person.”
Nic says that it’s important to reassure people that tinnitus is common and may resolve by itself. “There are no medications or supplements proven to be effective for tinnitus, and people should be discouraged from taking them,” they say. “Although serious underlying conditions are rare, it’s important to signpost a person experiencing tinnitus to their GP for assessment, ear examination and referral into ENT/Audiology services. The team at Tinnitus UK can provide information and support.”
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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.