An article from Professor Kevin Munro et al has been chosen as the number 1 paper published this year in the British Journal of General Practice. Here is what Editor Euan Lawson had to say:


Munro KJ, Giles TC, Smith-Howell C, Nazareth I. Ear wax management in primary care: what the busy GP needs to know. Br J Gen Pract 2023; DOI: (

There are a few reasons I plumped for this Clinical Practice article. After some comments about access to general practice that gave the opportunity to be a little self-righteous and pompous, it felt important to lighten the tone a little. Yet, this is a serious topic and one that can cause a lot of distress for patients. It is also one of our most downloaded papers of the year so it’s clearly attracting some interest.

Perhaps one of the key messages is that there is a lack of good evidence to guide care but from what can be gleaned here are some take-home messages:

  • a significant number of people fail to get the care they need for ear wax removal and there is an urgent need for such a service in primary care;

  • pre-treatment softeners are recommended followed by removal using electronic water irrigation or microsuction;

  • the use of modern portable equipment within a primary care network and for use in care homes is a possible approach; and

  • groups of practices rather than each individual practice can collaborate as primary care networks to provide a range of services, such as ear wax removal. The cost of setting up a video-assisted mobile ear wax suction service within a group of practices would involve an initial set-up and training cost-of around £1000, and any ongoing cost associated with rental of mobile equipment. However, the feasibility, clinical, and cost-effectiveness of this care pathway needs testing in an RCT.

Read the paper by Munro et al here