Introduction & module overview

There is increasing intention to commission ear health services from community pharmacies because demand is outstripping the limited provision of NHS audiology and community ear care services in many areas of the UK. 

The Government committed to “maximising Pharmacy First approaches to ENT” in its January 2025 plan Reforming Elective Care for Patients, which mentions ear infections and tinnitus.

Pharmacy First services have rapidly increased the number of pharmacists who are now trained and competent in clinical examination of the ear with an otoscope (also known as an auroscope). The availability of digital otoscopes used with a viewing screen, such as a smartphone, has made ear examination easier and more accessible.

The impact of hearing loss on an older person’s quality of life is often underestimated, with increased risk of a decline in mental/cognitive health, as well contributing to loneliness, depression and social isolation. Effective identification and management of hearing loss can help to reduce the risk of these adverse impacts.

Pharmacy teams have provided advice and support over many years for people with a build-up of earwax but have not traditionally provided earwax removal.

Community pharmacies in some areas of the UK have been commissioned to provide hearing health services and some pharmacies already offer a private service for earwax removal.

How common is hearing loss?

Hearing loss is very common and the prevalence increases with age. One large study found that hearing loss affected 42 per cent of people over 50 years of age in the UK, increasing to 71 per cent of people over 70 years old.

Age-related hearing loss (presbycusis) is the most common type, affecting around 9 million people. There is often a predisposition indicated by a strong family history.

The next most common type is noise-induced hearing loss (NIHL), which affects several million people in the UK.

It is estimated that by 2035 one in five people (around 13 million individuals) will have hearing loss in England – but the RNID suggests that even this may be an underestimate.

Much hearing loss goes unrecognised or unreported, and delays in getting assessment and corrective treatment are common.