Managing earwax in primary care: efficacy of self-treatment using a bulb syringe

Abstract

Irrigating ears to remove wax is a time-consuming procedure in UK primary care. In many other countries bulb syringes are used for self-clearance of earwax but evidence of their effectiveness is lacking. AimTo compare the effectiveness of self-treatment bulb syringes with routine care. Design of studyOpen, randomised, controlled trial. SettingSeven practices in Hampshire, UK. MethodParticipants were 237 patients attending their GP or practice nurse with symptomatic occluding earwax. A further 128 patients did not want to be part of the randomisation but allowed their data to be analysed. Patients randomised to intervention (n = 118) were given ear drops, a bulb syringe, and instructions on its use. Patients in the control group (n = 119) received ear drops, followed by ear irrigation by the GP or practice nurse. Main outcome measures were symptoms (on a 7-point scale), wax clearance, need for further treatment, and the acceptability of treatment. ResultsComparing patients using the bulb syringe with those treated with conventional irrigation, the change in mean symptom score was Ã0.81 and Ã1.26 respectively (difference Ã0.45, 95% confidence interval [CI] = Ã0.11 to Ã0.79) and, regarding the proportion requiring no further irrigation, 51% and 69% respectively. Although irrigation was preferred by more patients, most patients using the bulb syringe would use it again (75% versus 100%) and were satisfied with treatment (71% versus 99%). ConclusionsAdvising patients with ears blocked by wax to try bulb syringing before irrigation is effective and acceptable, and could significantly reduce the use of NHS resources.

How usual is usual care in pragmatic intervention studies in primary care? An overview of recent trials

“…Table 1 shows that the term 'usual care' was used in 33 of the 73 articles. Other expressions were also used, such as 'routine care', 15,29,35,63 'usual practice', 41 'normal care', 34 'standard care', 49,78 'care as usual', 55 'usual policy', 60 'usual service', 76 and 'usual management'. 84 Other authors did not use a specific expression.…”

The safety and effectiveness of different methods of earwax removal: a systematic review and economic evaluation

“…In the study by Coppin and colleagues, 63 at baseline 63% of participants in the self-irrigation group had a completely occluded right ear and 67% a completely occluded left ear. In the nurse irrigation group these proportions were similar (62% with completely occluded right ear and 69% with a completely occluded left ear).…”

“…Two RCTs 63,64 investigated the use of self-irrigation after participants had been assessed for earwax in primary care. One 63 compared self-irrigation to nurse irrigation in adult participants who had been given sodium bicarbonate to use for at least 2 days.…”

The safety and effectiveness of different methods of earwax removal: a systematic review and economic evaluation

“…Study sample sizes were typically small, varying from 36 participants 45 to 237 participants, 63 and only a few studies reported undertaking a sample size calculation (7 out of 24 studies 45,47,49,52,53,56,63 ). In some studies the overall population sample size was not reported, rather the numbers of ears were presented.…”

“…These trials fell into three categories: studies undertaken in primary care (14 studies [41][42][43][44][45][46][47][48][49][50][51][52][53][54] ), studies undertaken in secondary care (eight studies 4,[54][55][56][57][58][59][60] ), and studies of self-care or those undertaken in other care settings (four studies [61][62][63][64] ). Where the setting was in emergency care this has been grouped under primary care in the present review because it was assumed that this was the first point of contact with a health professional.…”