Randomized Trial of Irrigation and Curetting for Cerumen Removal in Young Children

Abstract

Objectives: To gather preliminary data on the effectiveness and feasibility of cerumen removal using three irrigation methods and a metal curette in young children. Study design: Pilot study conducted as a randomized clinical trial of well and ill children age 6 months to 6 years with ≥25% cerumen occlusion in at least one ear. Children were stratified by age and randomized to one of four methods of cerumen removal: syringe with attached angiocath tubing, Elephant Ear Washer Bottle System ® , OtoClear ® Spray Wash Kit, or metal curette. Clinicians, blinded from treatment assignment, assessed the degree of cerumen occlusion before and after the procedure. Outcomes included reduction in cerumen occlusion, successful removal, time until completion and parental satisfaction. Rules for stopping procedures were established a priori . Results: Thirty-eight children underwent procedures (59 ears). There were no significant differences in reduction in cerumen and successful removal among the methods. Overall, 36 (61%) of 59 of procedures were successful. The syringe with angiocath tubing took the most time ( P = 0.04) and resulted in the most stopped procedures ( P < 0.01). Parental satisfaction scores were not significantly different. Conclusions: Irrigation methods performed comparably to cerumen removal with curette; the SA method had drawbacks. Irrigation can be performed by non-clinicians, which is potentially a significant advantage. (Clinical trial registration: http://www.isrctn.com/ISRCTN74402562 ).

Cerumen Impaction Removal in General Practices: A Comparison of Approved Standard Products

“…A randomized trial of ear irrigation in children compared different irrigation methods and devices. 19 Successful cerumen removal was achieved without cerumenolytic pretreatment in 71% of participants using the same spray bottle irrigation device we used in our study. In our study, successful cerumen removal without pre-treatment was achieved in 64% of cases.…”

“…However, the spray bottle device was postulated to be particularly safe because its structure prevents deep penetration into the ear canal and water streams are aimed to the sides of the ear canal rather than directly at the tympanic membrane. 19 Using a syringe, constant water pressure cannot be guaranteed and depth and placement is difficult to control. 19 The age-group ≥70 showed less success in complete clearance of cerumen.…”

“…19 Using a syringe, constant water pressure cannot be guaranteed and depth and placement is difficult to control. 19 The age-group ≥70 showed less success in complete clearance of cerumen. This can be explained by physiological age-related structural changes in the ear canal and earwax.…”

“… 19 Using a syringe, constant water pressure cannot be guaranteed and depth and placement is difficult to control. 19 …”

Mechanism Cleaning of the Ear Canal

“…The main problem with irrigation is the risk of infection and dizziness that can result from it, both in clinical use [21] and in domestic use with tap water [22]. In both types of usage there are advantages and disadvantages [23]. Researchers recommend undertaking clinical studies before using this method to minimize the risks involved [6,24].…”