In episode 1 of this mini-series, Julia is joined by Frankie Oliver, Audiology Advisor at RNID to talk in more detail about their brand-new report from the national RNID charity (Royal National Institute For Deaf People) which outlines that people’s hearing health is at risk due to the axing of wax services in UK primary care provisions.

Not only do these changes to primary care provisions potentially put people’s health at risk, but Covid has also had a real knock-on effect for wax management across the board - and the Audiology industry is now desperately trying to play catch up.

Please find full episode transcript below.

Head to the RNID website to find out more about the report here.

Find out about their ear wax removal campaign here.

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FULL EPISODE TRANSCRIPT

[00:00:00] Julia: Hello and welcome back to Sounding It Out, a podcast dedicated to audiology and hearing health, brought to you by Signa UK and Ireland. I'm Julia van Huyssteen, your host, and I'm delighted to be back with four new episodes. I'm the head of audiology at Signa UK and Ireland and hearing health is something I am passionate about.

These podcasts are Signia neutral so that everybody with an interest in hearing health or audiology can benefit. If you're just discovering this series, we've already talked to legendary audiologist, Dr. Gus Mueller about hearing aid fitting standards. You can go back and download those previous episodes for free wherever you get your podcasts from and remember to follow so you don't miss any future episodes.

In this mini-series, we are discussing the wax management crisis we are facing here in the UK. It coincides with a brand new report from the RNID or Royal National Institute for Deaf People that was published in December 2022 and this report warns that people's hearing health is at risk due to the axing of wax services.

For background, the situation started to deteriorate in 2019 when the British Medical Association decided it would no longer be considered part of the core services GPs were obliged to provide. Data from 2020 shows that as many as 60% of patients that started direct audiology treatment did not complete their pathways.

And of course, Covid had a real knock on effect for wax management and as an industry we are desperately trying to play catch up. Accessing ear wax management through the NHS is also a postcode lottery and many individuals are accessing private wax removal at a cost. Some people told RNID they were quoted up to £400 for private removal.

Many people shared their experiences with RNID including Paul Clark. He lost his hearing through meningitis when he was a child. He used to get ear wax professionally removed but the service was stopped during the pandemic. These are his words voiced by someone else.

[00:02:24] Paul Clark:  I lost my balance and fell. I hit the ground really hard and thought I'd broken my arm. My balance issues were due to the build-up of earwax. So I contacted the GP who checked my ears. He gave me two options to either go private or go on a waiting list with the health trust. I thought about going privately, but it was too costly. I experienced a lot of discomfort and it had a severe effect on my communication with others. Eventually, I got an appointment, but it took over a year

[00:02:58] Julia: Later in the series, I'm going to be joined by three inspirational guests who have found new and inventive ways of tackling the problem in their trusts, and we will draw on that expertise. But first I'm joined by Frankie Oliver, Audiology Advisor at RNID to talk in more detail about their freshly published study. Frankie a warm welcome and thank you for joining us.

[00:03:22] Franki: Hi, Julia. Thanks for having me.

[00:03:24] Julia: Firstly, would you mind telling us who the RNID is for those listeners who may not have heard about the RNID before?

[00:03:31] Franki: RNID is the national charity, supporting people who are deaf have hearing loss or Tinnitus. There are 12 million people in the UK who are deaf or have hearing loss and RNID is here to make society more inclusive for everyone, provide support and information and to fund world class research

[00:03:49] Julia: A well worthy course, thank you, Frankie. And I know that RNID's campaign regarding wax management in the UK has been ongoing for some time. Maybe even since the BMA's decision. Could you ever have imagined the impact this decision would have, and therefore, why is this campaign so important?

[00:04:06] Franki: Yeah, we were receiving inquiries about earwax removal for some time prior to the Covid Pandemic, but this has really become a major issue. After the first lockdown in 2020, the number of inquiries we received just increased significantly with more and more people telling us they were unable to get ear wax removed on the NHS and were concerned about what to do, and then our concerns were then confirmed in an answer to a written parliamentary question in September, 2020, which stated that wax removal was no longer a core service. And then this sort of kickstarted our work into this properly.

I think as an audiologist, the potential impact that this decision could have, having been in clinic and had somebody with earwax and been unable help them or take an impression, for example, doesn't necessarily surprise me, but the scale of it is something that really does still surprise me at the moment.

I think the fact that it's such a national issue is really concerning and it just also highlights with what we hear every day from people why this campaign is so important. The impact that this decision is having on people's day-to-day life is something that is probably something I couldn't have imagined.

[00:05:17] Julia: I completely agree with you. We hear the conversations all around us. We hear it in audiology departments, we hear it in GP surgeries, we hear it even amongst private dispensers, so it is a very loud conversation and I think you're right, the numbers that this study shows really truly shows us the impact. So for me then talking about numbers it really makes sense to use data, to highlight the issue because we can talk about it amongst ourselves, but numbers is so powerful because we know that research gets taken a lot more seriously when you have good and representative numbers and good methodology.

So on that note then, can you talk us through the survey a little bit more? Maybe how long it took, how many people participated, how you went about conducting.

[00:06:01] Franki: You're right. The data to highlight the issue is so important, because we can talk about it among ourselves, and I think anybody in the audiology space in the UK knows it's an issue, but in order to make change and to get it taken seriously at a higher level, you need the data to back it up.

So we surveyed over 1400 adults between May and July of 2022, and all of them had reported having an issue in getting wax removed. We asked what advice they were given, what symptoms they experienced, whether they tried to remove wax themselves, and then what happened as a result, and then just the overall impact this was having on them to build a really strong picture of why this issue is so important.

[00:06:40] Julia: Wow, that really is a very large sample size, and as we've both just said, really important and a very good representative of these individuals with earwax. Now your campaign has a very strong message, namely that people are risking their hearing. Very important due to the axing of earwax services.

Now, that's a really strong wording, and I know why you've chosen it, but can you explain to our listeners why you felt to to use this strong wording?

[00:07:09] Franki: Yes, it is strong wording, but I don't think, and we had some time to think about how we wanted to stress this and I don't think we can really overstate the risks that people can pose when they are forced to try and remove wax themselves.

We know that people do put things in their ears that they're not supposed to, and there's not much we can really do about that other than providing very good advice and public health messaging. But the problem is when people are being forced to insert objects into their ears that they shouldn't when they're faced with no other option.

People are being forced to do this because private removal is either inaccessible or too expensive or they're just not able to access any care on the NHS. So people are using dangerous methods to try and remove wax. And then this is posing a risk to the really delicate anatomy of the middle ear and therefore posing a risk to someone's hearing.

So that's why we went with this quite strong message. I think there's also the concern that in the context of getting people to look at health issues on a whole, wax is often something that's, if you're not in the audiology space and you don't how important it is, it's often something that is regarded as a bit of a joke or something that's just a bit, it's just not very nice.

Not something that many people would consider as quite a serious issue unless it's happened to them or, it's happened to somebody they know and so they don't understand why it's so important. So I think that's why we went with that quite strong message. We want it to be taken seriously and we also want people to be aware that there is a risk if people are being forced to remove wax themselves by often quite dangerous methods.

[00:08:48] Julia: No completely agree with you. Think in order for people to take notice, we have to take these strong messages and to make people listen up. Because ultimately that is what we are trying to achieve with this campaign, and with this report is we want people, we almost want to shake people awake and say, listen, this is how big the problem is.

You are risking your hearing, by not providing wax renewal services through the NHS. You've got some interesting numbers as well in terms of the people who answered your survey, I think you mentioned that 73% of the people actually had earwax buildup. 73% of people or respondents with earwax buildup experienced hearing loss and 37% experienced tinnitus.

So this just drives that message home about the risk to your hearing by, not being able to access wax service. One of the questions in the survey was around private wax removal, and you've already mentioned it and referenced it. I mentioned in my introduction that some people were quoted 400 pounds for private wax removal. From your research

can you share with our listeners how much on average private wax removal costs? And actually, alongside with that, how many survey respondents said they, that they couldn't afford private wax removal?

[00:10:03] Franki: So yes, private removal is often for many people the only thing that's suggested to them and cost for this can range from 50 to a hundred pounds.

And that's either for one ear or for both ears. It's likely that we could see this cost increase as costs are generally increasing in the UK and around 26% of our survey respondents said that this was unaffordable and then they could not afford to get wax removed privately and this was especially a problem for people who have recurrent ear wax buildup, especially hearing aid wearers because they are more at risk and then they need ear wax removed regularly.

So I think it's also important to state that it's not necessarily a one-off cost of 50 to a hundred pounds, sometimes people can need wax of around three to four times a year. It's much higher than that one-off cost if they have to have it removed regularly as well, which makes it even more unaffordable for some people.

[00:10:58] Julia: Understandably so that's high numbers of people that almost have no way of getting the ear wax out of their ears. So considering that, then, considering the cost of private wax removal and the long waiting list, if you can access it through the NHS, you already said people resorted doing dangerous things.

Have you got some examples of what people reported in the survey, things that they've tried or whether they've tried and what they thought about the results?

[00:11:23] Franki: Yes, many respondents attempted to remove earwax themselves. But around two thirds of them said that they didn't actually feel confident removing wax themselves, which I think is quite worrying.

And then the methods that people described, fortunately lots of people used eardrops, which is what's recommended, but we had a lot of dangerous methods reported to us. People described using hair clips, paperclips, toothpicks, cotton buds, and in some cases Hopi ear candles, which we know are very dangerous.

And the advice to not put anything in your ear that's smaller than your elbow is so true here. And it was as an audiologist, reading through all of these different responses. It was really worrying to, basically see what people were being forced to do.

[00:12:10] Julia: I hear you. And as you were going through those examples, hair clips, paperclips, toothpicks, these are, very dangerous for somebody that doesn't understand the anatomy of the ear

like you and I do as audiologists so you can understand why it's so dangerous. Can you also then share some of the answers that you obtained on what people thought about it? Let's say they did try a hair clip, or let's say they did try a tooth thicker, a cotton bud. I wouldn't even talk about Hopi candles.

What they thought about the results when they did try it?

[00:12:40] Franki: So yeah, when you look at that list of methods, it does make you shudder a little bit. And when we look at what actually happens after people try to remove wax themselves, and a lot of the time people are being advised to do this. It's the kind of the first line of treatment.

Now one in 10 of people who said they tried to remove wax themselves said that they caused themselves injury or that their symptoms got worse. So sometimes it's even required medical attention. So things like perforated eardrum, bleeding, ear infections and even foreign bodies were reported to us. And then while obviously that's really concerning, it's also important to look at whether this is something that's effective and only 20% of respondents said that their symptoms went away.

And then 55% noticed no change at all. So I think this is important to consider when this is the kind of the first line of treatment and pre-treatment, ear wax softeners, like eardrops can be really helpful in removal. But I don't think they can be considered something that's going to completely solve the problem for everyone and this data kind of serves to highlight that.

[00:13:43] Julia: And the reality is the 20% of responders that said their symptoms actually went away, would've actually used the safer methods. And you already mentioned the eardrops for that. But we both know that's a very long-term treatment often, and it's something that has to be administered on a daily basis.

You've got to remember to do it, you've got to remember to keep it up. So actually, although it might be a solution for only 20% of the respondents, it actually meant the symptoms went away. So that brings me back to our message or your message of the RNID saying people are risking their hearing.

It brings them back to the point. Now in terms of why people or what people told you about their experiences, I know you have a couple of people that you might be able to tell us or share their stories with us. Is that okay? Can you share some stories with our audience?

[00:14:31] Franki: Yeah we have got a few stories and lots of people were, very open in telling us about their experiences. One that sort of stuck out to me in that it's not as, shocking in the sense that fortunately there was no injury or anything. But I think it just, it highlights that what was once quite a simple process has now become much more drawn out.

So one person told us that they were previously able to just call the GP practice say that they had wax, were advised to use eardrops, and then was able to book an appointment with the nurse within two weeks, say. Their experience now has taken them a significantly longer length of time, and it's partly because there's additional and probably unnecessary barriers in getting to that removal appointment.

So they mentioned having to see a GP twice before being able to see a nurse. And this just seems like a huge waste of not only the patient's time, but also GP time when we know that services are stretched at the moment, I think they said that the experience now took them maybe 10 or more weeks, and this was over the period of Christmas time, which meant that they had those 10 weeks of potentially having symptoms, meaning that they were unable to communicate with family and friends.

And I think that's quite...while it's not a story that talked about damage to the ear, and obviously we want to highlight those stories of unsafe practice, but also just the fact that, what was once quite a simple and straightforward thing to deal with is now much harder. And that was a running theme throughout the results that we received.

I think other important impacts to highlight were on people's mental health as well. So we had someone saying that actually made them feel scared to leave the house. Because of a loss of independence, because they were unable to hear people, which I think is just, it's just awful that someone's being forced to experience that.

And I think we also had somebody say that because they were unable to hear because of wax and they were unable to get an appointment, they actually had to take time off work, which again, is another, a huge impact on somebody's kind of day-to-day life. So yeah, those are some of the stories that we experienced and all were very kind of big themes of impacts on just being able live day to day.

[00:16:44] Julia: So yes, understandably if you have got a hearing loss, for example, because of ear wax or if you're experiencing tinnitus because of ear wax, we're not just talking about the hearing symptoms here, we are talking about the wider impact on somebody's mental health, and as you mentioned, the example of somebody that wasn't able to work.

So we are really talking about very profound impacts here. And therefore, going back to our message risking your hearing health, but taking that even further into your mental health and your general wellbeing too. So on that note then, my last question for you now is really a result of the interview that we have or the conversation actually that we've had up until this point, and that is, what is the RNID hoping to achieve in a nutshell, just summarize for us, what is the RNID hoping to achieve from this campaign? What are the main things that you are calling for?

[00:17:33] Franki: Most importantly, we want earwax removal, to be fully funded on the NHS and in line with NICE guidelines, which calls for earwax removal to be provided in primary and community settings for people who have a clinical need. Another theme that we found through our research was that advice people are being given.

It's not totally clear or consistent, so we'd like the NHS to publish this advice and make it available not only to patients, but also professionals and healthcare staff as well. And then finally, we completely understand that the system is very stretched at the moment. And then asking a GP practice to provide something that they're currently not getting funding for

it's not necessarily the only option and I think there's lots of options to explore and I know that there's pilots going on at the moment of various different ways that this can be delivered. So is going back to primary care, the only answer, probably not. So we want the Department of Health and Social Care, NHS England, local health authorities, to look at different ways that this could be delivered and different models of delivery.

Something that could be delivered in pharmacy settings. Is it something that could be delivered in audiology settings? And then once we get the information from these pilots to then share this with other health authorities, really explore different and innovative ways that we can offer this service. Because the most important thing is that people have access to timely, safe, and appropriate services on the NHS.

[00:18:58] Julia: Brilliant answer. Thank you so much for that, Frankie, and thank you for sharing the details of the report. I was aware of the wax management crisis, but this piece of work really drives the wider impact home.

The RNID is a well-respected voice in our industry, and now we need to ask ourselves, what do we do with this data? The three priorities that the RNID are calling for and highlights the problem and makes it a pressing and urgent conversation for primary care, the Department of Health and Social Care and NHS England. So let's have that conversation.

You can find out more about the research and indeed the invaluable work from the RNID by looking at their website and social feeds. All details are on the episode page. In the next episode, I'll be speaking to Mark Newman, who is the Head of Audiology at the Barking, Havering and Redbridge University Trust, who has come up with a really fresh approach to ear wax removal.

[00:20:01] Mark: So what I managed to do was actually negotiate a audiology lead wax removal clinic with a full blessing of the ICBs as they are now, or the CCGs as they were then, which was meant we had a fully funded, audiology led wax removal clinic. So sometimes you need to do a little bit of manoeuvring and ensure you're in the right meetings with the right people in order to make effective change.

[00:20:23] Julia: If you found any of what you've heard today helpful, please tell your colleagues so as many people as possible can share the knowledge. And if there is a topic you think we should be covering, drop us an email to the address on the show page. Remember to follow wherever you get your podcasts so you don't miss an episode.

This is a Fresh Air Production for Signia UK and Ireland. Until next time. Goodbye and goodbye, Frankie.