Community pharmacy is in the right place to provide advice and treatments for a variety of ear ailments, from ear wax to ear infections…

The ear care market has not flourished recently but it is by no means a market that pharmacists can afford to neglect.

Volume sales of ear care products fell by 1% in 2012, according to Euromonitor International, who described that as “a significantly poorer performance than that seen over the review period” in a report released in July this year.

The report went on to say that consumers’ spending on ear care was “cautious,” with many non-committal about spending their cash on what Euromonitor described as “non-essential purchases.”

The report said: “Some consumers were less willing to spend on non-essential purchases and were looking for lower-cost alternatives. These included traditional home treatments such as using olive oil in the ears, rather than purchasing a specific product for an ear ailment.”

What was encouraging in the report as far as pharmacy is concerned, however, was its suggestion that consumers are likely to seek quick help from their local pharmacist rather than wait for a doctor's appointment because of the severity of pain ear ailments bring. 

“That said, the decline was small; despite some frugality, ear problems tend to develop quickly and can be extremely uncomfortable, which thus encouraged consumers to self-medicate, seeking help and advice from a pharmacist rather than having to wait for a doctor’s appointment,” the report added.

The competitive landscape, it observed, was condensed, with a small number of brands dominating the category, such as Otex from Dendron (31% value share in 2012), Cerumol from Thornton & Ross (26% value share) and Earex from Reckitt Benckiser (16% value share).

And what of the future of the ear care market? The report was pretty clear. “Ear care (was) forecast to increase by a CAGR (compound annual growth rate) of 2% in constant value terms between 2007 and 2012, to a total of £12 million.”


Pharmacist's view
Altaf Vaiya, community pharmacist who runs Alpharm Chemist in Leicester, provides his expert advice on ear care…

Ear wax can be a real problem. The symptoms of ear wax build-up include difficulty in hearing, pain in the ear, tinnitus, a blocked feeling in the ear and/or temporary deafness after swimming or having a bath or shower. 

Most of the products we sell over the counter are products designed to soften and loosen the wax, making it easier to remove, for instance Cerumol, Earex, Exterol and Otex. The use of these products should alleviate this ailment, however if there is no improvement then referral to a doctor may be required.

Sodium bicarbonate ear drops are also used to soften dry and hardened earwax. This reduces the need for wax to be physically removed but also makes ear irrigation easier when removal is necessary.

Customers also prefer using olive oil ear drops. Olive oil is unlikely to cause any irritation, but takes quite a long time to have an effect on the wax. When recommending ear drops, it should be reminded that at first, they may make the ears feel more blocked up as the wax softens and expands. But, it needs to go through this phase so that it can come out of the ear.

Usually when there is a big build-up of wax, syringing is needed. The treatment involves flushing out the wax with a stream of water and there are some syringing kits available over the counter. However, this is usually undertaken by practice nurses.

Other ear ailments include otitis media, which is an infection of the middle ear common among children because of the shape of the young Eustachian tube. This can affect adults too. The symptoms include pus, fluid and inflammation inside the middle ear.

It can also cause severe earache, hearing loss, fever and tinnitus. If otitis media is left untreated, it can result in ruptured eardrum, causing severe deafness and pain. The main treatment is a course of antibiotics.

Glue ear is another common ailment which is chronic otitis media – it occurs after a long-term build-up of thick or sticky fluid in the middle ear behind the eardrum, causing hearing loss. Glue ear commonly affects children.

Otitis externa is another ailment; it is a bacterial or fungal infection that affects the ear canal. It commonly occurs is children, occurring when too much water gets inside the ear, removing the protective ear wax coating in the ear canal and making it easier for germs to thrive. This is usually called ‘swimmer’s ear.’ The use of ear plugs can help prevent water getting into the ears.

The symptoms include pain and itching, dulled hearing and ear discharge. EarCalm spray (containing acetic acid) is available for the treatment. Treatment should be continued until two days after symptoms have disappeared, but no longer than seven days.

This product acts as an anti-fungal and anti-bacterial in the external ear canal. Licensed in children and adults over 12 years and over, another product called Swim-Ear is also available to remove water that maybe trapped inside the ear.

Children especially under 12 should be seen with extra care, as referral to a doctor is usually needed where severe pain and deafness occurs. Simple advice such as never inserting anything into their ears is essential.

Cotton buds, fingers or other small objects should never be used to clean the ears because they will simply push the ear wax deeper into the ear canal, increasing the build-up.

We need to remind our customers of how fragile our ears really are, the skin of the ear canal and ear drum for instance is very thin and fragile and is therefore easily injured. Acute pain and deafness can occur in extreme cases.

The key active ingredients in some of the ear treatment products include Arachis oil, urea hydrogen peroxide and choline salicylate. Having some knowledge of the ingredients will help reinforce the use of these products.

We should give additional advice on ear care, for instance cleaning ears with extra care; wipe the outer ear with a wash cloth or tissue. Q-tips, bobby pins or sharp pointed objects should not be used in the ear; these objects may injure the eardrum.

Furthermore pierced ears need to be looked after, cleaning earrings and earlobes regularly with a salt-based cleanser. It is also essential to be vigilant about some medicines that can affect ears, as some can lead to balance problems, ringing in the ears and unusual hearing.

Hearing protection at home or at work is also important, during exposure to loud levels of noise. For instance, mowing the lawn, leaf blowing or using power tools by law, a noisy environment requires use of hearing protection.

Ear protecting headgear can also be useful to advice. Furthermore, ear buds, such as those that come with an IPOD or MP3 player, do not protect hearing. High volume levels should be avoided.

Other important advice includes; when flying in an aeroplane, swallow and yawn frequently when the plane is ascending and descending to equalize pressure in your ears. If patients come in with an upper respiratory problem such as a cold or sinus infection, advising them to take a decongestant a few hours before descending, or use a decongestant spray just prior to descent and on landing can help. 

In fact, earplugs with special filters can be purchased to help equalise air pressure in ears during ear travel.

We should make an effort to be active clinicians when it comes to ear care. We need to provide customers with the right advice on the various conditions and treatment options available and make sure we get our category management right by placing the most popular products where customers will see them easily.

If we do not show good evidence-based knowledge and recommend the most suitable products, our roles in the healthcare profession may be undermined. Taking an active approach to learning is of paramount importance.

Customer's views
Mike from Leicester
I prefer using olive oil ear drops because they are the simplest but most effective ear drops for gently softening the wax. I use a dropper to apply the oil more easily and that warms the oil to body temperature. But you have to lie down before inserting the oil.

Meera from Leicester
If we do not make an effort to look after our ears, then detrimental effects in the long term are likely. Pharmacists should dedicate a section of their pharmacies to ear care, including information leaflets with products specific to ear ailments.
They should display products, ensuring they look eye-catching and draw customers in. Even though ear care may not be such a large sales point within pharmacies, pharmacists must still make an effort to educate their customers and recommend the best products for their ear ailments.

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