This is the final part of a 4 part mini-series about the UK’s earwax crisis. Throughout the series industry experts have been talking about the innovative ways their clinics have for addressing the earwax problem. In this episode, we’re finding out first hand what it’s like using the Earways Pro tool. It’s been put into practice at the Southeastern Health and Social Care Trust. Nora McDonald is the Acting Adult Lead Audiologist at the trust and is Julia’s guest. For more information about Earways Pro head to their website Contact Nora at Nora.Macdonald@setrust.hscni.net Got a topic you think we should be talking about? Get in touch here: marketing.uk@signia-hearing.com For more information about Signia UK and Ireland, visit their website Sounding it Out by Signia, is produced by Annie Day from Fresh Air Production. FULL TRANSCRIPT [00:00:00] Julia: Hello and welcome back to Sounding It Out, the podcast dedicated to audiology, brought to you by Signia UK and Ireland. I'm Julia van Huyssteen, your host and Head of Audiology at Signa. This is the fourth and final episode of the miniseries about the wax management crisis we are facing here in the UK. All the guests in this mini- series have found new and inventive ways of tackling the issue in their trusts, and are sharing their experiences and expertise with you. Last time we heard from Nicola Phillips, who is the Principal Clinical Scientist and Head of Primary Care Audiology at Swansea Bay University Health Board. Nicola talked to us about how her trust implemented an audiology led primary care earwax removal service. [00:00:52] Nicola: All our patients access primary care audiology through their GP surgeries. In some practices, patients get triaged by the receptionist and book directly into audiology slots, or the wax removal slots. In other practices GPs will triage over the phone and then book them directly into clinics using a shared booking system. [00:01:10] Julia: If you've missed the first three episodes, you can go back and download them for free wherever you get your podcasts. Today, let me introduce you to Nora McDonald, who is the Acting Adult Lead Audiologist at the Southeastern Health and Social Care Trust. She is going to be sharing her experiences of using the Earways Pro Tool. Hello Nora. [00:01:34] Nora: Hi, good morning Julia, thanks for having me. [00:01:38] Julia: Nora, thank you for joining us as guest speaker. Although you've only recently started using the Earways Pro tool, you have some great experiences you can share with us today. Before we start getting into the nitty gritty, where did you first hear about the Ear Earways Pro tool and what about it made you pay attention? [00:01:55] Nora: Our Audiology and ENT manager, Barbara Greg, had noticed it at the 2021 BA conference. We had long ENT waiting lists after covid and more and more patients were presenting to the audiology appointments with obstructive wax. Of course, we're always interested in exploring any wax management options including alternatives for microsuction. [00:02:20] Julia: So it sounds to me like the impact was both on ENT and audiology. Of course that would be something that makes you pay attention to an alternative method that could actually ease the service. Now, what did the ear removal service exactly look like in your trust before introducing the Earways Pro tool? [00:02:39] Nora: So the ENT specialist nurses manage the wax removal service. They manage their own waiting lists, reviewing patients as and when required, and accepting new referrals from audiology or ENT as indicated. The audiology service in our trust works across four individual sites and we don't always run alongside the ENT microsuction nurse. So if we were faced with obstructive wax within an audiology appointment and didn't have access to a nurse to remove it, the majority of patients would've been advised to contact their GP for wax removal locally, provided obviously that they had no contraindications for local management. We tried to limit referrals to the nurse-led microsuction clinics to those who warranted that specialist ENT attention. For example, the atypical ears perforations, mastoid cavities, history of otitis, surgery, collapsing ear canals, et cetera. But obviously due to a combination of the Covid pandemic and the withdrawal of many local GP wax removal services, our ENT waiting list for microsuction was just... grew longer and longer, so it became quite a big problem that we needed to address. [00:03:57] Julia: Wow. I can really see the impact of limited wax removal opportunities across the four sites too. And of course you also limited wax removal opportunities within primary care, so going back to primary care then, what was the GPs and your trusts response together, I guess, to this problem previously? What did you do, was private wax removal and option, and what was the feedback from the patients around these waiting times or potential wax removal at a cost? [00:04:26] Nora: I can't speak too much on behalf of the GPs, but as far as our department is concerned we added as many additional ENT microsuction clinics as possible in an attempt to tackle the waiting list. But of course, we have all the usual staffing and equipment demands. Patients were obviously understandably disappointed to learn of the long waiting list for microsuction within the trust and would explore options on the high street for a quicker alternative. This is obviously not always an accessible option for patients due to the associated costs, and it obviously doesn't sit well with us as NHS audiologists to suggest this as an option. Our department is always re-evaluating and exploring all options, including further wax removal training and equipment for audiologists and we are hopeful that the use of the Earways Pro tool in audiology appointments will reduce the referral rate and lift that pressure of the ENT microsuction waiting lists. [00:05:25] Julia: Understandably yes. And actually, I mean you talk about the waiting lists, but what about any data around, for want of a better word, wasted appointments due to patients presenting with wax? You mentioned earlier, I think in the first answer, that often you were presented with patients with wax and you didn't have access to ENT wax removal. Many of those appointments would of course not be able to be completed. Can you share with us any figures at all? [00:05:53] Nora: Yeah, unfortunately not on that specific area of wasted appointments, I suppose it isn't something we've been able to reliably audit because now that we have the Earways Pro tool, that would involve a huge retrospective study to investigate all the appointments where wax contraindicated a procedure so that's not something we've managed to to reliably assess. [00:06:18] Julia: That makes sense. But I think from the conversation so far, what I hear is that from both the trust perspective the audiology and ENT and from the patient's perspective, it pretty much wasn't everybody's interest to think outside of the box and look at alternative methods, so good on you, really. So at this point, I just think it's important for us to highlight to our listeners that the Earways Pro tool is regulatory approved. It's a medical device and it's for used by trained professionals. Just emphasizing trained professionals. For our listeners benefit at this point, for those who have not seen the tool before or hasn't got any experience with it, shall we attempt to describe more or less what it looks like and how it functions? [00:07:06] Nora: The tool is a slim, handheld single-use device with a small grip handle and a flexible helical head. They come in small, medium, and large. In terms of the circumference of the spiralled head, patients often comment actually when shown it that they've seen similar online to buy. But I do point out, as you've just said, that the Earways Pro tool is medically approved device only to be used by trained professionals and shouldn't be available to purchase online. I tend to highlight the main difference between the Earways Pro tool and similar commonly advertised to purchases that the helical head at the top is a completely open spiral, so that prevents impacting the wax further the same way a cotton bud would. [00:07:54] Julia: Yeah. So with that spiral head the Earways Pro is designed to spiral around the wax and engulf it. And you've mentioned that open-ended tip and then because it's spiralling around the wax, we are not pushing it further into the canal. We're just simply pulling it straight after the ear. So it is very cleverly designed to be safe to use. Now my next question considering that ENT was previously pretty much solely responsible, whether nurses or surgeons or doctors for the wax removal, what was their view or what is their view actually on the Ear Earways Pro? Did they have any training from you or anybody else? Have they actually made an effort to observe you using the tool, considering that they are ENT specialists? Were they positive or were they negative? And have they actually mentioned any impact in their own clinics in terms of waiting times in people coming for wax removal? [00:08:53] Nora: Yeah, so it's our ENT nurses that lead the microsuction waiting lists as opposed to ENT in general. The nurses were very intrigued and supportive. They recognize that the Earways Pro will hopefully enable us to help those more typical layers within an appointment that the patient's already attending and allow them, the EENT nurses, to concentrate back on those patients with the more complex presentations who require their specialist attention or the microsuction procedure. In terms of any impact on their clinics yet? It's still early days. We are definitely seeing it, but I think at this stage, they're just ticking over, absolutely swamped. So at the moment we haven't quite audited. [00:09:40] Julia: So perha
