A quasi-randomised controlled trial of water as a quick softening agent of persistent earwax in general practice

Abstract

Background: Earwax is a common problem in general practice. The incidence of complaints owing to earwax in general practice in the Netherlands is 39.3 per 1000 patients. Aim: To determine the feasibility of a strategy using water as a quick dispersant for persistent earwax, compared with the usual strategy using oil as a dispersant for three days in a general practice setting. Design of study: Practice based, prospective controlled intervention study. Setting: Forty-two patients (59 ears) in four general practices in the Netherlands. Method: Patients with persistent earwax were randomised into an intervention group and a control group. For patients in the intervention group, water drops at body temperature were dropped into the impacted ear and the auditory meatus was blocked with a wet wad of cotton. After the patient had waited for 15 minutes in the waiting room a series of attempts at syringing was completed. Patients in the control group received the usual strategy and were instructed to soften the earwax with oil each night before sleeping and to block the auditory meatus with a wad of cotton, for three days. They were asked to come back after three days for the second attempt of syringing. For both strategies the mean number of syringing attempts (and 95% confidence interval) was calculated and compared by testing the difference between the means using a t-test for independent samples. All ears in which the wax was still persistent after another five syringing attempts were given the value of 6 in the calculations. Results: The mean number of syringing attempts needed per patient in the intervention group was 3.0 (95% CI = 2.4 to 3.6) and for the control group, the mean was 2.4 (95% CI = 1.7 to 3.1). The difference between means (0.6, 95% CI = 0.3 to 1.5) was not statistically significant (P = 0.18). Conclusion: A patient with persistent earwax can stay in the waiting room following the initial series of five attempts at syringing, with water instilled in the ear canal. After 15 minutes, the earwax is removed as easily as in the usual strategy using oil instilled for three days. The strategy using water as a dispersant for persistent earwax is quick and more convenient for the patient.