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Painful ears (otalgia) – may be the result of aural disease or referred pain from head or neck.

Otitis externa

Painful inflammation of the skin that lines the external auditory meatus. Common, often associated with swimming.

Acute otitis media (OM)

Painful infection (bacterial or viral) of the middle ear.

Chronic suppurative OM

Persistent drainage from the ear, associated with tympanic membrane perforation and often a degree of conductive hearing loss.

Serous/secretory OM (glue ear)

Non-suppurative fluid in the middle ear. An important cause of childhood hearing loss.

 Unilateral serous effusion in an adult needs urgent referral.

Ear examination Recommended Procedure. British Society of Audiology (BSA), 2016 


Normally, earwax is eliminated from the ear canal spontaneously through natural movement of the jaw. However, if wax is retained in the canal it may become impacted. Earwas should be removed if it is totally occluding the ear canal, and: 

  • The person is symptomatic
  • The tympanic membrane is obscured but needs to be viewed to establish a diagnosis
  • The person wears a hearing aid, and an impression needs to be take for a mould, or the wax is causing the hearing aid to whistle.

Initial management includes ear drops for 3–5 days to soften the wax. If symptoms persist, ear irrigation can be considered, providing that there are no contraindications, e.g. 

  • Perforated tympanic membrane
  • Active dermatitis or infection of the ear canal or acute otitis externa
  • Abnormalities of the ear canal 
  • Grommets in place
  • History of ear surgery, middle ear infection, any previous problem with irrigation 

Irrigation should only per performed by an experienced practitioner who has received recognised training in ear care and the use of ear care equipment.

Practice Nurse featured article

Ear care and irrigation with water: an update Hilary Harkin

When not to irrigate and How to irrigate Clinical topic: earwax

Ear irrigation guideline (2019) Primary Care Ear Centre and Audiology Services


All parents in England are offered hearing screening for a new child at 0–5 weeks. Subjective hearing tests in children are not guaranteed to be exact, and the value of screening tests is often questioned.

Newborn Hearing Screening

Royal National Institution for the Deaf offers support for families


The biggest single cause of hearing impairment is age. Slight age-related hearing loss (presbycusis) begins in most people at 30–40 years, and by 80 years of age most have significant impairment. Another common cause is loud noise (acoustic trauma).

Assessment/detection Adults who think they have a hearing loss should be tested as soon as possible and referred as appropriate to an ENT specialist or audiologist. Some simple tests can be carried out in general practice, but formal audiometry is preferable. Ask ‘Do you have a hearing problem?’ on new-patient questionnaires and during health checks for older people.

Presbyacusis. Professional reference

British Society of Audiology Audiometry Recommended procedures for routine clinical use with adults and children

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