A recent BBC report has reignited the long-running debate about whether cotton buds should be used to clean ears — a practice that the NHS and most audiologists have warned against for years. For the millions of people who experience earwax build-up, discomfort, or temporary hearing changes, the community pharmacy remains one of the most accessible first points of contact for advice and treatment.

Why cotton buds are problematic

According to NHS guidance, inserting cotton buds into the ear canal risks pushing wax further in, potentially causing impaction, and can damage the delicate skin of the ear canal or, in extreme cases, the eardrum. Despite these warnings, cotton buds remain one of the most commonly used — and misused — household items for ear care.

Community pharmacists regularly encounter patients seeking help with ear symptoms that have been caused or worsened by cotton bud use. The pharmacist's role in these consultations is twofold: advise on safe ear care practices and recommend appropriate over-the-counter treatments.

OTC ear care products available in pharmacies

Community pharmacies in England stock a range of over-the-counter products for ear care, broadly falling into three categories:

Ear drops for wax softening:

• Olive oil ear drops — the simplest and often most recommended first-line treatment
• Sodium bicarbonate ear drops — dissolve wax through a gentle chemical reaction
• Hydrogen peroxide-based drops — effervescent action to loosen compacted wax
• Urea-based preparations — soften hardened wax over several days

Ear hygiene products:

• Saline ear sprays — gentle irrigation for regular ear hygiene
• Ear bulb syringes — for home irrigation (with caution)
• Silicone ear plugs — for swimming, noise protection, and travel

Pain and infection support:

• Analgesic ear drops — for temporary pain relief from earache
• Oral analgesics (paracetamol, ibuprofen) — for ear pain management

When to see a pharmacist first

For many ear complaints, a visit to the pharmacy is the most appropriate first step. Pharmacists can advise on:

• Earwax build-up — recommend appropriate drops and advise on safe self-care
• Ear pain without fever — suggest pain relief and monitor symptoms
• Water trapped after swimming — advise on drainage techniques and prevention
• Itchy ears — identify possible causes and recommend topical treatments

Under the Pharmacy First service, introduced in 2024, pharmacists in England can also provide clinical consultations for earache, including assessment, advice, and in some cases the supply of prescription-only medicines without a GP appointment. The service is available at no cost to the patient and attracts a £15 NHS consultation fee for the pharmacy.

When to refer to a GP or specialist

Pharmacists are trained to identify symptoms that require onward referral. Red flags for ear complaints include:

• Sudden hearing loss in one or both ears
• Discharge from the ear (particularly if blood-stained or foul-smelling)
• Persistent pain accompanied by fever
• Symptoms following head injury
• Ear pain in children under two years old
• Foreign objects in the ear canal

In these cases, the pharmacist will advise the patient to see their GP or attend A&E, depending on severity.

The scale of ear care demand

Ear-related consultations represent a significant volume of community pharmacy activity, though precise figures are not routinely published. Earwax removal was removed from many NHS GP services in recent years as part of wider service rationalisation, which has redirected a substantial portion of demand toward pharmacies and private ear care clinics.

For patients, the community pharmacy offers several advantages: no appointment is needed, pharmacies are typically open longer hours than GP surgeries, and pharmacists can provide immediate product recommendations. England's 13,147 registered community pharmacies — searchable via PharmSee's pharmacy finder — provide near-universal geographic access to ear care advice.

Practical advice for ear care

Based on NHS guidance and pharmacist recommendations:

1. Do not insert anything into the ear canal — including cotton buds, hair grips, or fingers
2. Use olive oil drops for two to three weeks if experiencing mild wax build-up
3. Tilt and gently pull the ear after showering to drain trapped water
4. Visit a pharmacist if symptoms persist after self-treatment
5. Seek urgent care if experiencing sudden hearing loss, severe pain, or discharge

For pharmacists and pharmacy staff, ear care consultations are an opportunity to demonstrate clinical value, build patient trust, and — through Pharmacy First — generate additional NHS service revenue. For the latest on pharmacy services and locations, visit PharmSee.