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Treating earwax

Systematic review
Results
Clearing earwax without syringing
Successful syringing
Comment

It is awfully embarrassing visiting your doctor complaining about progressive deafness, only to be told that your ears are blocked with wax and need syringing. Earwax is probably useful for something, but it is tiresome stuff. Earwax removers even appear in all those Roman medical kits found in archaeological excavations. Dealing with earwax is a long-standing problem, so a systematic review [1] of preparations to help deal with it should make life easier.

Systematic review

Four electronic databases were searched up to June 2003 for trials, earwax experts contacted, and manufacturers of preparations asked for clinical trials. For inclusion trials had to evaluate eardrops in properly randomised trials, and the drops could be of any type. The outcomes chosen and relevant were those of clearance of earwax without syringing, or the outcome of successful syringing after treatment.

Results

Eighteen trials were found, all more than 10 years old, and some were published as long ago as the 1950s. Four trials were regarded as high quality (maximum scores for allocation sequence, concealment, inclusion of all patients, and blinding), and most were small. Many treatments were compared in only one trial.

The small number of patients and trials means that statistical analysis is probably inappropriate. Results below are therefore the pooled percentage success rates from at least two trials, with the numbers of patients in parenthesis.

Clearing earwax without syringing

Figure 1 shows available information. Based on small numbers, preparations containing docusate or triethanolamine polypeptide had about the same efficacy as saline. None was more than 20% effective in clearing earwax without syringing. Treatment for four days may be better than treatment for shorter periods, but evidence is not extensive.



Figure 1: Ears cleared spontaneously (number of patients)





Successful syringing

Figure 2 shows available information. Based on small numbers, preparations containing docusate or triethanolamine polypeptide had about the same efficacy as saline. Dioctyl was about the same as maize oil or olive oil, but these oil-based treatments were no different from water-based treatments. All were about 60-70% effective in clearing earwax with syringing. Treatment for 30-60 minutes was as effective as longer periods.



Figure 2: Ears successfully syringed (number of patients)





Comment

There we have it. No one treatment is demonstrably better than any other in a series of trials. There is very weak evidence that a choline and glycerol product may be better than average for both outcomes, but there is just not enough trial evidence. Nor were rare and possibly serious adverse events looked at. Earwax removal procedures resulted in chronic tinnitus in 11 of 2,400 (0.5%, or 1 in 200) consecutive patients in one survey [2].

This lack of evidence is disappointing. There just isn't enough evidence about which to be certain, but if you use saline or olive oil it is unlikely that there is anything better. Anyone who thinks their product is better had better find a way of proving it.

Two randomised trials have been published since the search in 2003. One [3] found no difference between docusate, triethanolamine polypeptide or saline in visualising tympanic membrane in children aged six months to five years. The other [4] found no difference between triethanolamine polypeptide, carbamide peroxide, and saline followed by low pressure water irrigation (though saline did best).

On one hand we are probably not that much further on from our Roman ancestors with their olive oil and spatulas. On the other, when that jet of warm saline makes us feel that any wax is coming out the other ear, we can at least take solace from the fact that there is nothing else known to be a better alternative.

References:

  1. C Hand, I Harvey. The effectiveness of topical preparations for the treatment of earwax: a systematic review. British Journal of General Practice 2004 54: 862-867.
  2. RL Folmer, BY Shi. Chronic tinnitus resulting from cerumen removal procedures. International Tinnitus Journal 2004 10: 42-46.
  3. VN Whatley et al. Randomized clinical trial of docusate, triethanolamine polypeptide, and irrigation in cerumen removal in children. Archives of Pediatric and Adolescent Medicine 2003 157: 1177-1180.
  4. PS Roland et al. Randomized, placebo-controlled evaluation of Cerumenex and Murine earwax removal products. Archives of Otolaryngology Head and Neck Surgery 2004 130: 1175-1177.

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