Ear drops for the removal of ear wax

  • Conclusions changed
  • Review
  • Intervention

Authors

  • Martin J Burton,

    Corresponding author
    1. Oxford Radcliffe Hospitals NHS Trust, Department of Otolaryngology - Head and Neck Surgery, Oxford, UK
    • Martin J Burton, Department of Otolaryngology - Head and Neck Surgery, Oxford Radcliffe Hospitals NHS Trust, Level LG1, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK. mburton@cochrane-ent.org.

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  • Carolyn Doree

    1. NHS Blood and Transplant, Systematic Review Initiative, Oxford, UK
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Abstract

Background

Problems attributed to the accumulation of wax (cerumen) are among the most common reasons for people to present to their general practitioners with ear trouble. Treatment for this condition often involves use of a wax softening agent (cerumenolytic) to disperse the cerumen, reduce the need for, or facilitate syringing, but there is no consensus on the effectiveness of the variety of cerumenolytics in use.

Objectives

To assess the effectiveness of ear drops (cerumenolytics) for the removal of symptomatic ear wax.

Search methods

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008 issue 2); MEDLINE; EMBASE; CINAHL; ISI Proceedings; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was April 2008.

Selection criteria

We identified all randomised controlled trials in which a cerumenolytic was compared with no treatment, a placebo, or other cerumenolytics in participants with obstructing or impacted ear wax, and in which the proportion of participants with sufficient clearance of the external canal to make further mechanical clearance unnecessary (primary outcome measure) was stated or calculable.

Data collection and analysis

The two authors reviewed all the retrieved trials and applied the inclusion criteria independently.

Main results

Nine trials satisfied the inclusion criteria. In all, 679 participants received one of 11 different cerumenolytics. One trial compared active treatments with no treatment, three compared active treatments with water or a saline 'placebo', and all nine trials compared two or more active treatments. Eight trials included syringing as a secondary intervention.

Overall, results were inconclusive. The majority of comparisons showed no difference between treatments.  Meta-analysis of two high quality trials produced a statistical difference in favour of triethanolamine polypeptide over saline in preventing the need for syringing, but no other significant differences between treatments.

In three trials of high to moderate quality, no difference was found between the effectiveness of either sodium bicarbonate ear drops, chlorbutanol, triethanolamine polypeptide oleate condensate or docusate sodium liquid versus a sterile water or saline 'placebo'.

One trial of moderate methodological quality found all three treatments - sodium bicarbonate ear drops, chlorbutanol and sterile water - to be significantly better than no treatment at preventing the need for syringing.

None of the higher quality trials demonstrated superiority of one agent over another in direct comparisons.

Authors' conclusions

Trials have been heterogeneous and generally of low or moderate quality, making it difficult to offer any definitive recommendations on the effectiveness of cerumenolytics for the removal of symptomatic ear wax. Using drops of any sort appears to be better than no treatment, but it is uncertain if one type of drop is any better than another. Future trials should be of high methodological quality, have large sample sizes, and compare both oil-based and water-based solvents with placebo, no treatment or both.

Plain language summary

Using ear drops to remove impacted ear wax is better than no treatment, but no particular sort of drops can be recommended over any other

Impacted ear wax is one of the most common reasons that people visit their general practitioners (family doctors) with ear problems, as it can cause reduced hearing, discomfort, and sometimes pain and dizziness. Ear drops (either oil- or water-based) are often prescribed to clear the wax or to aid subsequent ear syringing if necessary. The review of trials found that ear drops (of any sort) can help to remove ear wax, but that water and saline drops appear to be as good as more costly commercial products. The quality of the trials was generally low, however, and more research is needed.

Laički sažetak

Kapi za uklanjanje nakupljenog cerumena su bolje nego nikakva terapija, ali se ne zna koje su kapi najdjelotvornije

Nakupljeni cerumen (ušna smola) je jedan od najčešćih razloga posjeta obiteljskom liječniku zbog problema s uhom jer može uzrokovati oslabljen sluh, osjećaj nelagode te ponekad bol i vrtoglavicu. Kapi za uši (koje se temelje na uljnim i vodenim preparatima) često se propisuju za uklanjanje cerumena ili kao dodatak ispiranju. Ovaj Cochrane sustavni pregled istraživanja je pokazao kako bilo koje kapi za uho mogu pomoći pri uklanjanju cerumena, a da su one bazirane na vodi i natrijevu kloridu (slane) jednako dobre kao i one skuplje. No, kvaliteta dokaza je niska te su potrebna dodatna istraživanja.

Bilješke prijevoda

Hrvatski Cochrane
Preveo: Igor Vlatković
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr