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

Abstract

BACKGROUND: 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. AIM: To compare the effectiveness of self-treatment bulb syringes with routine care. DESIGN OF STUDY: Open, randomised, controlled trial. SETTING: Seven practices in Hampshire, UK. METHOD: Participants 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. RESULTS: Comparing patients using the bulb syringe with those treated with conventional irrigation, the change in mean symptom score was -0.81 and -1.26 respectively (difference -0.45, 95% confidence interval [CI] = -0.11 to -0.79) 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%). CONCLUSIONS: Advising 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.