Why the NHS stopped doing ear wax removal in 2019 — and what changed

The 2019 NHS England commissioning decision

In the 2018–19 commissioning cycle, NHS England reclassified ear wax removal as a service that should be provided by audiology specialists rather than by primary care. The mechanism was the publication of new commissioning guidance: 'Ear wax management for the NHS' from NHS England's commissioning framework, supported by NICE Clinical Knowledge Summary updates. Primary-care GP contracts no longer routinely funded the service.

The reasoning given was twofold. First, water irrigation — then the most common primary-care technique — carries non-trivial complication rates (perforation, otitis externa, vertigo), and the volume of complaints had been rising. Second, NHS England wanted any wax removal performed in the context of audiology assessment, on the rationale that wax causes hearing problems and any hearing problem deserves a proper audiology evaluation.

The intention was sensible on paper. The execution created a service vacuum.

What actually happened in practice

Audiology departments were already running at capacity in 2019 — they hadn't been resourced to absorb the volume of wax-removal referrals that now landed on them. Three things followed:

• Wait times in many areas (including Greater Manchester) stretched to 12–18 months and in some places exceeded two years.
• Patients with simple wax problems were funnelled into full audiology pathways including detailed hearing tests they didn't necessarily need.
• Private providers — audiology clinics, ENT outpatients and pharmacy-based services like ours — filled the gap. By 2022 the private market for ear wax removal in the UK had expanded substantially.

For patients with hearing aids — who can't tolerate wax buildup because the aid is occluded — the delays became serious. Older patients reliant on hearing aids for daily function were waiting months to have an ear cleared. NICE updated the CKS in subsequent years to reflect the reality, and many ICBs have since piloted re-commissioning of wax-removal services, but coverage remains patchy.

Why audiology referral often isn't the right pathway

For a straightforward wax problem in an adult with no hearing concerns and no other ear symptoms, the audiology pathway is over-specified. You don't need a full hearing assessment to clear wax. You don't need a tympanometry. You need a clinician with good equipment and direct vision to remove the wax safely. That's what microsuction is. Adding a hearing test on top of microsuction costs money, takes time, and isn't clinically necessary when the symptom is 'I can't hear because of wax' rather than 'I can't hear and we don't know why.'

Where audiology referral genuinely is appropriate: unexplained or progressive hearing loss, tinnitus, vertigo, suspected ear-drum perforation, history of ear surgery, or any unusual canal finding. In those cases we refer to ENT or NHS audiology even when we've performed the microsuction — the audiology workup matters for those presentations.

How to access private microsuction without an unnecessary hearing assessment

If your symptom is wax buildup with mild hearing loss or fullness and you have no other ear concerns, what you need is microsuction, not a full audiology package. A few things to look for in a private provider:

• Registered healthcare professional on site. Pharmacist, nurse, audiologist or ENT specialist — the title matters less than registration with a regulatory body (GPhC, NMC, HCPC, GMC).
• CQC registration or equivalent regulatory oversight. For a pharmacy-based service, GPhC premises registration provides that oversight. Empire Pharmacy is GPhC-registered (premises 1123966) with Haroon Iqbal as superintendent (reg. 2051093).
• Microsuction not irrigation. Microsuction is dry, performed under direct vision, and carries lower risk. See our guide on microsuction vs irrigation vs drops.
• No upselling. A reputable provider doesn't push a full hearing test on every patient. We'll mention it only if your symptoms suggest you need one, and we'll refer rather than upsell.
• Clear pricing. Both ears in one visit should be a single transparent price. See our pricing page.

What NICE CKS says in 2026

The current NICE Clinical Knowledge Summary on earwax recommends:

• Asymptomatic wax doesn't need removal. Wax is normal and protective — it migrates out of the canal naturally in most people.
• Symptomatic wax (hearing loss, fullness, tinnitus, itch, otalgia related to impaction) warrants removal.
• First-line is cerumenolytic drops (olive oil, sodium bicarbonate, or hydrogen peroxide) for 3–5 days.
• If drops don't clear, microsuction is the preferred technique, especially in patients with perforation history, grommets, recent ear surgery, only one functional ear, or active infection history.
• Irrigation remains an option in low-risk patients but has fallen out of favour as microsuction has become more widely available.

When NHS provision returns — should you wait?

Some Greater Manchester ICBs have piloted re-commissioning of community wax-removal services. If you can wait 12–18 months and your wax is mild, by all means. For most of our patients the wait isn't reasonable — either because hearing aid use makes wax untenable for that long, or because daily life is disrupted (work meetings, telephone conversations, family conversations all become a struggle).

The honest answer is that private microsuction now fills a niche the NHS chose to vacate. It's not 'queue-jumping' — it's accessing a service the NHS no longer provides routinely. That's a different category of choice.

What we offer in Old Trafford

Microsuction at Trafford Clinic uses a binocular operating microscope, calibrated low-pressure suction, and disposable sterile tips. Both ears in 15–30 minutes. Haroon is a GPhC-registered pharmacist and Independent Prescriber with 26 years of experience. If we find anything that needs ENT input, we refer.

We see patients from across Greater Manchester: Manchester city centre, Old Trafford, Salford, Salford Quays, Sale, Altrincham, Stretford, Chorlton, Rusholme, Eccles, Whalley Range and Firswood.

How to book

Book at traffordclinic.co.uk/ear-health or call 0161 258 6149. Use olive oil drops twice daily for 2–3 days before your appointment if your wax is hard — it speeds the procedure.

Related reading: Microsuction vs syringing vs ear drops.