Earwax is produced to help keep the ears clean and free from dirt and germs. Typically, earwax falls out naturally, but in some people the wax can build up and harden causing symptoms such as earache, difficulty hearing, itchiness, dizziness, ear infections and tinnitus (sounds such as high-pitched tones coming from inside the ear).

Some people are more prone to earwax build up if they:

• Naturally have more wax in their ears
• Have hairy or narrow canals (the tubes that link the eardrum and outer ear)
• Wear hearing aids, earplugs and other things you put in your ear that can push the wax further in.

Age can also be a factor, as wax gets harder and does not fall out as easily as we get older. Earwax can usually be removed by using eardrops containing oils or chemicals. Oils soften the earwax and help it to fall out. Chemicals, such as urea hydrogen peroxide, dissolve the earwax. Some drops contain a combination of the two.

If the ear doesn’t clear after five days of treatment or the ear is badly blocked and the customer is unable to hear, you should refer them for earwax removal. You could refer them to Boots Hearingcare* or some GP practices will provide this treatment.

Customers with recurrent earwax should be advised to use the drops on an ongoing basis to help keep the wax soft.

The symptoms of an ear infection usually start quickly and include: pain inside the ear; a high temperature of 38°C or above; being sick; a lack of energy; difficulty hearing; discharge running out of the ear; a feeling of pressure or fullness inside the ear; itching and irritation in and around the ear; and scaly skin in and around the ear.³

There are two types of ear infections:

• Otitis media – an infection of the inner ear, which is more common in children. It is associated with colds and flu and affects the eustachian tube.
• Otitis externa – an infection of the outer ear, which is common in people over 45 years. It is caused by something irritating the ear canal, such as eczema, water or wearing ear plugs.

Most ear infections will clear within a week and any pain or discomfort can be managed with paracetamol or ibuprofen, as appropriate. If it is an infection of the outer rather than inner ear, there are drops containing acetic acid available, which stop the spread of bacteria or fungus. To relieve pain and itching, there are drops that contain a local anaesthetic.

Some outer ear infections may be prevented by using specialist earplugs or drops when swimming to prevent water entering the ears.

Sinusitis is swelling of the sinuses, usually caused by an infection and often occurring after a cold or flu. It's common and usually clears up on its own within two to three weeks. Symptoms of sinusitis include: pain; swelling and tenderness around the cheeks, eyes or forehead; a blocked nose; a reduced sense of smell; green or yellow mucus from the nose; a sinus headache; a high temperature; toothache; and bad breath.⁴

You can advise customers to manage their symptoms with:

• Paracetamol or ibuprofen for the pain
• Saline nasal sprays or rinses
• Decongestant nasal sprays, drops or tablets to relieve congestion
• Steam inhalation, possibly with a few drops of essential oil, to clear the nasal passages.

You should refer customers to their GP if:

• Symptoms are severe
• Painkillers do not help or their symptoms get much worse
• Symptoms do not improve after one week
• They are affected by recurrent sinusitis.

When mucus drips and collects down the back of the throat it can cause a condition called post-nasal drip, the symptoms of this include a sore throat, cough/frequent throat clearing and hoarseness. Symptoms can be relieved by reducing the amount of congestion and lifestyle changes such as sleeping propped up on pillows.⁵