Stockport NHS Foundation Trust

3. Mr N complains about the care and treatment he received during a microsuction procedure at the audiology department at Stockport NHS Foundation Trust in May 2024.

4. Mr N says the consultant who attended to him did not explain the procedure to him and did not ask for his consent. Mr N says the consultant then performed the procedure on his right ear which he had previously had no issues with.

5. Mr N says the procedure has caused damage to his hearing in his right ear.

6. Mr N would like a financial remedy of up to £2000 to cover the cost of hearing aids.

7. Mr N’s GP referred him to the audiology department at the Trust in May 2024 after a hearing test identified some asymmetric hearing loss in his left ear (a significant difference in hearing ability compared to the right ear).

8. Mr N then had an appointment at the department in May 2024 where the ENT specialist performed a microsuction procedure to remove some wax from his ears.

9. Mr N then had a further appointment at the Trust in September where he said he thought the procedure had damaged his hearing. The records of the appointment show the consultant explained Mr N had evidence of sensorineural hearing loss (hearing loss caused by damage to the inner ear or auditory nerve).

10. The Trust then advised Mr N to try bilateral hearing aids and discharged him from its service.

15. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.

16. Mr N said the Trust performed a microsuction procedure on him without explaining it to him and seeking his consent. Mr N says the consultant conducted the procedure on his right ear which he had not had any issues with before and caused damage to his hearing.

17. The Trust said it is standard practice to examine the normal or unaffected side first and then to examine the side with symptoms. It said Mr N’s right ear canal and ear drum view was obstructed by wax and this was an indication to perform microsuction.

18. Microsuction is a widely used procedure in otology (the study of the anatomy and diseases of the ear) clinics to remove wax and foreign objects from the external ear canal. It works by using a medical-grade suction device to gently suck impacted earwax, debris or foreign objects out of the ear canal, while a clinician views the process through a microscope or otoscope for precise control and safety.

19. NICE quality standards for hearing loss in adults say audiologists carry out earwax removal in adults when it is contributing to other symptoms or is preventing ear examination. Methods that can be used include ear irrigation, microsuction or manual removal.

20. Additionally, clinical guidance from ENT UK, in cooperation with the British Society of Audiology (BSO), says microsuction is indicated for several reasons which include:

• ‘clearance of obstructive materials that are causing conductive hearing loss • removal of material that is obstructing the view of the ear canal or tympanic membrane and preventing adequate assessment • removal of debris to aid in the resolution of external or middle ear infections • clearance to enable effective use of a hearing aid.’

21. Our ENT adviser said in line with these standards and guidelines, microsuction was an approved method and was appropriate for Mr N’s symptoms.

22. Mr N said the Trust did not explain the procedure and its associated risks to him before carrying it out and he did not get an opportunity to consent.

23. The Trust said Mr N told staff he had previously had his ears cleaned out on many occasions and so staff felt a detailed discussion about a procedure he had prior experience of was not necessary. The Trust said it obtained Mr N’s verbal consent, and he willingly agreed to have the procedure carried out.

24. The Trust said microsuction procedures do not require written consent as patients give implied consent by submitting themselves to the procedure. It said however that the consultant would always speak to patients before and seek their verbal consent, as she did in this situation.

25. The ENT UK guidance we have already referred to says it is important that the process, the likely experience and potential risks are fully discussed with the patient prior to proceeding with microsuction. The guidance clarifies that it is not necessary for the details of this consent to be recorded, and consent is implied by the fact that the patient submitted themselves to the procedure.

26. Our adviser said it would not be expected for the Trust to ask for written consent prior to the procedure, but staff would be expected to fully discuss the procedure and any potential risks with Mr N beforehand.

27. The records of the procedure are not extensive, although they state Mr N had told the consultant he regularly has his ears syringed.

28. Based on the available evidence, we have not seen any indications the Trust failed to discuss the procedure with Mr N or seek his consent.

29. Mr N said the procedure has caused damage to his hearing.

30. The Trust said during and following the procedure, Mr N did not express any discomfort, dizziness, coughing or say it was too loud.

31. These are common issues patients report when undergoing microsuction, which are listed in the ENT UK guidance. The guidance also lists the risks of the procedure, which can include temporary or even permanent sensorineural hearing loss. It explains that this is a very rare complication that can occur from injury to the ear drum.

32. The Trust said the audiologists checked Mr N’s ear after the procedure and did not note any signs of trauma. It said the hearing assessment Mr N had undergone prior to the procedure showed evidence of sensorineural hearing loss in the right ear.

33. We recognise it has been very difficult for Mr N to deal with and understand his hearing loss. We do not underestimate how challenging an experience this has been.

34. We have carefully considered the available evidence, and we have seen no indications the Trust did anything wrong in performing the microsuction procedure and giving Mr N the relevant information to make an informed decision. Additionally, there is nothing to suggest the procedure caused any hearing loss. We hope Mr N is reassured by this.

1. We have carefully considered Mr N’s complaint about the Trust. We are sorry to hear about Mr N’s hearing loss, and we recognise this has been a difficult time for him.

2. We have reviewed all the available evidence, and we have not seen any indications the Trust has done anything wrong.