Ears are self-cleaning so they don’t need much daily care, beyond being cleaned on the outside and kept as dry as possible. But when ear problems do strike, they can cause discomfort and customers may look to the pharmacy to find some relief.
Poking cotton buds and other small objects inside the ears to clean them can cause long-lasting damage, pushing ear wax further inwards and making ear problems worse. So what advice should be given to customers about ear health, and which items should pharmacies stock to cater for their needs?
Ear wax helps to protect, clean and lubricate the ears, keeping them free from germs and debris. Some people are naturally prone to excess ear wax, especially as they get older or if they use hearing aids, earplugs or earphones. If excess ear wax blocks the ear, it can cause pain, itching and even tinnitus or hearing loss.
Pharmacy customers may be able to soften their ear wax themselves with over-the-counter products. Ear wax softening drops, such as those containing urea peroxide, may help to loosen wax and ease any symptoms. If these cause irritation or drying, using olive oil ear drops twice a day for one or two weeks can be recommended instead – this doesn’t need to be warmed before use.
If the ear wax blockage still doesn’t clear, or the customer can’t hear properly, they should be referred to a GP or practice nurse. The National Institute for Health and Care Excellence (NICE) guideline on hearing loss in adults from June 2018 recommends that GP surgeries offer to remove ear wax with ear irrigation using an electronic irrigator, microsuction or another method of ear wax removal, such as manual removal using a probe, but not manual syringing, if the ear wax is contributing to hearing loss or other symptoms.
Pain in or around the ear isn’t usually a sign of anything serious. It may be caused by excess ear wax or a self-limiting middle or outer ear infection. Sometimes, it can be triggered by teeth grinding, temporomandibular joint dysfunction (TMJ) or a dental infection, as the nerves in the face and neck are closely linked.
Earache usually gets better after a few days. Customers should be advised to take appropriate painkillers – ibuprofen may be more effective if there is any inflammation – and gently hold a warm or cold flannel against their ear when the pain is at its worst. If the pain is very bad or doesn’t get better after a week, customers should see a GP to check for an underlying cause.
If customers experience pain when they touch their ear, they may have inflammation of the outer ear canal, known as otitis externa. The ear may also look red and feel sore and itchy. Otitis externa is often called swimmer’s ear, as it can be triggered by repeated exposure to water, but other causes include an allergy, irritation or eczema.
Painkillers can help to ease any pain, while acidic ear drops or sprays may help to treat any infection. It’s important to keep the ears dry to prevent further problems. Customers can use protective ear drops before swimming, showering or anything that involves getting the head wet – these create a natural barrier to seal the ears. They can also use earplugs and wear a tightly fitting swimming cap to protect their ears.
Otitis media, or middle ear infections, are most common in children, although adults can get them too. They can be triggered by a cough or cold – anything that increases nasal congestion and mucus build-up. The infection causes an accumulation of fluid behind the eardrum, which leads to earache, a raised temperature and slight hearing loss. In very bad cases, the eardrum can tear, leaking pus and blood into the outer ear canal.
Acute middle ear infections usually clear up on their own after a few days or up to a week. NICE guidance on middle ear infections, published in March 2018, suggests regular doses of paracetamol or ibuprofen for pain – decongestants and antihistamines don’t seem to help. Antibiotics aren’t usually prescribed for middle ear infections, as most cases are viral rather than bacterial. However, if customers have any red flag symptoms, such as severe pain, fever, vomiting, fluid from the ear or hearing loss (especially sudden and/or on one side), they should be referred to a GP.
Some people notice a full or stuffy feeling in their ears when they’re on a plane or fast-moving train, when scuba diving or travelling in mountainous areas. Also known as ear barotrauma, this occurs when air pressure around the ear changes quickly and the eustachian tube that runs from the nose to the ear becomes blocked. Other symptoms may include pain, dizziness and a loss of hearing. This is often the reason why babies and young children cry on a flight, especially during landing.
The symptoms usually only last for a few minutes before the ears ‘pop’ once the eustachian tubes open up again. But if customers are prone to longer-lasting symptoms, they may benefit from wearing special ear plugs for air travel, which balance pressure changes in the ears. It may also help if they suck on a boiled sweet, chew gum or drink water during take off and landing. Babies and young children could suck on a bottle or dummy. If customers have any nasal congestion from a cold or allergy when they’re flying, using a decongestant nasal spray before the flight may help to prevent earache.
Dulled hearing, especially in children, can be a sign of glue ear. This occurs when the empty middle part of the ear canal fills up with a glue-like fluid rather than air. The fluid doesn’t drain away, instead causing a blockage.
Glue ear doesn’t always cause symptoms, although it occasionally causes slight earache and tinnitus, so may not be diagnosed straight away. Parents may only realise there is a problem when their child turns the television volume up high or doesn’t seem to listen when they’re being spoken to. Glue ear usually clears up within three months on its own, but any hearing problems should always be checked out by a GP. Mild earache can be eased with painkillers, but there’s no evidence that other medicines, such as antihistamines, decongestants or antibiotics, can help.
If the hearing loss persists after three months, children are usually referred to a specialist ear, nose and throat (ENT) consultant for further tests. A GP may suggest trying a balloon treatment called auto-inflation, which helps the fluid in the ear to drain away. Auto-inflation nasal devices to use at home are available on prescription or for self-purchase from pharmacies. Some children with glue ear may need to have surgery to clear the fluid and insert grommets (ventilation tubes) if the problem persists.
Tinnitus – buzzing, whistling or whooshing sounds in the ears – often occurs after exposure to loud noise, although it can also be associated with nasal congestion, ear infections or stress. Recent statistics from Action on Hearing Loss revealed that most people have experienced ringing in the ears after a night of partying, but six million are living with tinnitus continually.
Tinnitus usually gets better over time, perhaps because people stop noticing the sounds after a while. If pharmacy customers experience symptoms of tinnitus for longer than 24 hours, they should visit their GP. Tinnitus isn’t usually caused by anything serious, but it can cause profound hearing loss, which may lead to permanent damage. Tinnitus can’t be cured but relaxation and mindfulness may help to reduce stress levels, which then makes the tinnitus seem less severe. There are also several tinnitus apps available for mobile phones and tablets. If customers have some hearing loss, a hearing aid may help. If tinnitus is particularly troublesome, customers can have tinnitus retraining therapy, a combination of counselling and sound therapy, which uses low-level sound generators.
To prevent noise-related tinnitus and hearing loss, community pharmacies can stock suitable earplugs to wear during noisy activities. Customers should wear noise-cancelling headphones when they listen to music, as this means they don’t have to turn the music up high over background noise. Over-the-ear headphones are better for the ears than those with earbuds that sit in the ear and it is also important to turn down the music volume to at least 60 per cent.
Vertigo is a feeling of spinning and can be caused by problems with the inner ear, such as labyrinthitis or benign paroxysmal positional vertigo (BPPV), which is caused by specific head movements. It may also be associated with migraine, TMJ, sinusitis and some medicines. Sometimes, vertigo is associated with some hearing loss, a feeling of fullness in the ears and tinnitus, as well as nausea and vomiting.
The terms vertigo and dizziness are often used interchangeably. But dizziness is feeling lightheaded, faint or unsteady without any spinning or perception of movement. A vertigo attack can last from a few seconds to a few hours and often affects balance. This can be a particular problem in elderly people who already have an increased risk of falls.
Vertigo usually gets better over time, but should be assessed by a GP. If it is caused by labyrinthitis, customers will be advised to rest in bed until the spinning feeling has gone and avoid bending down or turning their head. A GP may prescribe medicines, such as corticosteroids, antibiotics if there is an underlying infection and anti-emetics for sickness or vomiting. Customers should also be advised to avoid alcohol, bright lights, noise and any stress.
Poking cotton buds and other small objects inside the ears to clean them can cause long-lasting damage