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

Health Technology Assessment

Volumn 14, Issue 28, 2010, Pages

  Clegg, A J ^a   Loveman, E ^a   Gospodarevskaya, E ^a   Harris, P ^a   Bird, A ^a   Bryant, J ^a   Scott, D A ^a   Davidson, P ^a   Little, P ^a   Coppin, R ^a  

^a UNIVERSITY OF SOUTHAMPTON   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ACETIC ACID; AGENTS ACTING ON THE AUDITORY AND VESTIBULAR SYSTEMS; ALMOND OIL; BICARBONATE; CERUMOL; CHLORBUTOL; CHOLINE SALICYLATE; DOCUSATE SODIUM; GLYCEROL; OLIVE OIL; SODIUM CHLORIDE; TRIETHANOLAMINE POLYPEPTIDE OLEATE CONDENSATE; UNCLASSIFIED DRUG; UREA HYDROGEN PEROXIDE; UREA PEROXIDE; WATER; VEGETABLE OIL;

ARTICLE; BURNING SENSATION; CERUMEN IMPACTION; CLINICAL EFFECTIVENESS; CLINICAL TRIAL; COST EFFECTIVENESS ANALYSIS; DIZZINESS; DRUG COST; DYSPNEA; EAR BLEEDING; EAR DISEASE; EAR DRYNESS; EAR PRURITUS; EAR SORENESS; EAR STINGING; EARWAX REMOVAL; ECONOMIC EVALUATION; ENDOSCOPIC DE WAXING; FACE SWELLING; HEARING IMPAIRMENT; HUMAN; INTERMETHOD COMPARISON; LAVAGE; LIP SWELLING; MICROSCOPIC DE WAXING; OTALGIA; PATIENT CARE; QUALITY OF LIFE; RASH; SAFETY; SKIN IRRITATION; SWELLING; SYSTEMATIC REVIEW; TASTE DISORDER; THROAT SWELLING; TINNITUS; TONGUE SWELLING; TREATMENT RESPONSE; URTICARIA; CERUMEN; CLINICAL TRIAL (TOPIC); COST BENEFIT ANALYSIS; ECONOMICS; METHODOLOGY; PRIMARY HEALTH CARE; QUALITY ADJUSTED LIFE YEAR; REVIEW; STATISTICAL MODEL;

CERUMEN; CLINICAL TRIALS AS TOPIC; COST-BENEFIT ANALYSIS; HUMANS; MODELS, ECONOMIC; PLANT OILS; PRIMARY HEALTH CARE; QUALITY-ADJUSTED LIFE YEARS; SODIUM BICARBONATE; THERAPEUTIC IRRIGATION;

EID: 77954379492     PISSN: 13665278     EISSN: None     Source Type: Journal    
DOI: 10.3310/hta14280     Document Type: Article

References (94)

1. Burton MJ, Doree CJ. Ear drops for the removal of ear wax. Cochrane Database Syst Rev 2003;3:CD004326.
2. Serafin J. Using colace (docusate sodium) to remove cerumen impactions. Geriatric Nurs 2008;29:34.
3. Stone M, Fulghum RS. Bactericidal activity of wet cerumen. Ann Otol Rhinol Laryngol 1984;83:183-6.
4. Keane EM, Wilson H, McGrane D, Coakley D, Walsh JB. Use of solvents to disperse ear wax. Br J Clin Pract 1995;49:71-2.
5. Lewis-Cullinan C, Janken JK. Effect of cerumen removal on the hearing ability of geriatric patients. J Adv Nurs 1990;15:594-600.
6. Sharp JF, Wilson JA, Ross L, Barr-Hamilton RM. Ear wax removal: a survey of current practice. BMJ 1990;301:1251-3.
7. Crandell CC, Roeser RJ. Incidence of excessive/ impacted cerumen in individuals with mental retardation: a longitudinal investigation. Am J Ment Retard 1993;97:568-74.
8. Memel D, Langley C, Watkins C, Laue B, Birchall M, Bachmann M. Effectiveness of ear syringing in general practice: a randomised controlled trial and patients' experiences. Br J Gen Pract 2002;52: 906-11.
9. McCarter DF, Courtney AU, Pollart SM. Cerumen impaction. Am Family Physician 2007;75:1523-8.
10. Burkhart CN, Burkhart CG, Williams S, Andrews PC, Adappa V, Arbogast J. In pursuit of ceruminolytic agents: A study of earwax composition. Am J Otol 2000;21:157-60.
11. Guest JF, Greener MJ, Robinson AC, Smith AF. Impacted cerumen: composition, production, epidemiology and management. QJM 2004;97: 477-88.
12. Brister F, Fullwood HL, Ripp T, Blodgett C. Incidence of occlusion due to impacted cerumen among mentally retarded adolescents. Am J Ment Defic 1990;15:594-600.
13. Oliveira RJ. The active ear canal. J Am Acad Audiol 1997;8:401-10.
14. Roeser RJ, Ballachanda BB. Physiology, pathophysiology, and anthropology/epidemiology of human ear canal secretions. J Am Acad Audiol 1997;8:391-400.
15. Ryan TJ, Sinclair R. Diseases of the skin. In Warrell DA, Cox TM, Firth JD, Benz EJ, editors. Oxford textbook of medicine. Oxford: Oxford University Press; 2003. pp. 809-94.
16. Robinson AC, Hawke M, Naiberg J. Impacted cerumen: a disorder of keratinocyte separation in the superficial external ear canal? J Otolaryngol 1990;19:86-90.
17. Hanger HC, Mulley GP. Cerumen: its fascination and clinical importance: a review. J R Soc Med 1992;85:346-9.
18. Stoeckelhuber M, Matthias C, Andratschke M, Stoeckelhuber BM, Koehler C, Herzmann S, et al. Human ceruminous gland: ultrastructure and histochemical analysis of antimicrobial and cytoskeletal components. Anat Rec A Discov Mol Cell Evol Biol 2008;228A:877.
19. Omoto K. Polymorphic traits in peoples of eastern Asia and the Pacific. Isr J Med Sci 1973;9:1195-215.
20. Hawke M. Update on cerumen and ceruminolytics. Ear Nose Throat J 2002;81(Suppl. 1):S1-4.
21. Karlsmose B, Lauritzen T, Engberg M, Parving A. A randomised controlled trial of screening for adult hearing loss during preventive health checks. Br J Gen Pract 2001;51:351-5.
22. Davis AC. The prevalence of hearing impairment and reported hearing disability among adults in Great Britain. Int J Epidemiol 1989;18:911-17.
23. Fairey A, Freer CB, Machin D. Ear wax and otitis media in children. Br Med J 1985;291:387-8.
24. Flugrath J, Lutz D, Hamdy RC. Hearing impairment and cerumen impaction in older patients. J Tenn Med Assoc 1993;86:301-2.
25. Hawthorne MR, Nunez DA, Clarke GP, Robertshaw D. Direct referral hearing aid provision in the over sixties age group. J Laryngol Otol 1991;105:825-7.
26. Lim JK, Yap KB. Screening for hearing impairment in hospitalised elderly. Ann Acad Med Singapore 2000;29:237-41.
27. Office for National Statistics. Mid-2006 population estimates: estimated resident population by broad agegroup. National Statistics Online; 2008. National Statistics: London. Accessed 14 July 2008.
28. Roland PS, Smith TL, Schwartz SR, Rosenfeld RM, Ballachanda B, Earll JM, et al. Clinical practice guideline: cerumen impaction. Otolaryngol Head Neck Surg 2008;139:S1-21.
29. Hand C, Harvey I. The effectiveness of topical preparations for the treatment of earwax: a systematic review. Br J Gen Pract 2004;54:862-7.
30. Allen S. Outer and middle ear problems. Pharm J 2006;276:83-6.
31. Coppin R, Wicke D, Mehta R, Little P. Management of earwax in primary care: postal survey of UK GPs and practice nurses. Fam Pract 2004;21:413-14.
32. Wilson PL, Roeser RJ. Cerumen management: professional issues and techniques. J Am Acad Audiol 1997;8:421-30.
33. NHS Quality Improvement Scotland. Best practice statement: ear care. Edinburgh: Scottish Executive; 2006.
34. Blake P, Matthews R, Hornibrook J. When not to syringe an ear. NZ Med J 1998;111:422-4.
35. Sorensen VZ, Bonding P, Sorensen VZ, Bonding P. Can ear irrigation cause rupture of the normal tympanic membrane? An experimental study in man. J Laryngol Otol 1995;109:1036-40.
36. Freeman RB. Impacted cerumen: how to safely remove earwax in an office visit. Geriatrics 1995;50:52-3.
37. Browning G. Ear wax. Clin Evid 2008;15:504-13.
38. Pothier DD. How we do it: Technical note: endoscopic removal of cerumen. Clin Otolaryngol 2006;31:153-5.
39. Arulkumaran S, Skurr B, Tong H, Kek LP, Yeoh KH, Ratnam SS. No evidence of hearing loss due to fetal acoustic stimulation test. Obstet Gynecol 1991;78:283-5.
40. NHS Centre for Reviews and Dissemination. Undertaking systematic reviews of research on effectiveness. CRD Report 4. 2nd edn. York: University of York; 2001.
41. General Practitioner Research Group. A wetting agent to facilitate ear syringing. Practitioner 1965;195:810-12.
42. Pavlidis C, Pickering JA. Water as a fast acting wax softening agent before ear syringing. Aust Fam Physician 2005;34:303-4.
43. Burgess EH. A wetting agent to facilitate ear syringing. Practitioner 1966;197:811-12.
44. Dummer DS, Sutherland IA, Murray JA. A singleblind, randomized study to compare the efficacy of two ear drop preparations ('Audax' and 'Cerumol') in the softening of ear wax. Curr Med Res Opin 1992;13:26-30.
45. Lyndon S, Roy P, Grillage MG, Miller AJ. A comparison of the efficacy of two ear drop preparations ('Audax' and 'Earex') in the softening and removal of impacted ear wax. Curr Med Res Opin 1992;13:21-5.
46. Meehan P, Isenhour JL, Reeves R, Wrenn K. Ceruminolysis in the pediatric patient: a prospective, double-blinded, randomized controlled trial. Acad Emerg Med 2002;9:521-2.
47. Whatley VN, Dodds CL, Paul RI. Randomized clinical trial of docusate, triethanolamine polypeptide, and irrigation in cerumen removal in children. Arch Pediatr Adolesc Med 2003;157:1177-80.
48. General Practitioner Research Group. Wax softening with a new preparation. Practitioner 1967;199:359-62.
49. Singer AJ, Sauris E, Viccellio AW. Ceruminolytic effects of docusate sodium: a randomized, controlled trial. Ann Emerg Med 2000;36:228-32.
50. Jaffe G, Grimshaw J. A multicentric clinical trial comparing Otocerol with Cerumol as cerumenolytics. J Int Med Res 1978;6:241-4.
51. Amjad AH, Scheer AA. Clinical evaluation of ceruminolytic agents. Eye Ear Nose Throat Monthly 1975;54:76-7.
52. Carr MM, Smith RL. Ceruminolytic efficacy in adults versus children. J Otolaryngol 2001;30:154-6.
53. Eekhof JA, de Bock GH, Le CS, Springer MP. A quasi-randomised controlled trial of water as a quick softening agent of persistent earwax in general practice. Br J Gen Pract 2001;51:635-7.
54. Fahmy S, Whitefield M. Multicentre clinical trial of Exterol as a cerumenolytic. Br J Clin Pract 1982;36:197-204.
55. Caballero M, Navarrete P, Domenech J, Bernal-Sprekelsen, M. Randomized clinical trial of clorobutanol, sodium carbonate, and irrigation in cerumen removal in adults (abstract). XVIII IFOS World Congress; 2005.
56. Pothier DD, Hall C, Gillett S. A comparison of endoscopic and microscopic removal of wax: a randomised clinical trial. Clin Otolaryngol 2006;31:375-80.
57. Dubow E. A simple method to assure proper pediatric ear examinations. Arch Pediatr 1959;76:360-3.
58. Saloranta K, Westermarck T. Prevention of cerumen impaction by treatment of ear canal skin. A pilot randomized controlled study. Clin Otolaryngol 2005;30:112-14.
59. Chaput de Saintonge DM, Johnstone CI. A clinical comparison of triethanolamine polypeptide oleatecondensate ear drops with olive oil for the removal of impacted wax. Br J Clin Pract 1973;27:454-5.
60. Fraser JG. The efficacy of wax solvents: in vitro studies and a clinical trial. J Laryngol Otol 1970;84:1055-64.
61. Hinchcliffe R. Effect of current cerumenolytics. Br Med J 1955;2:722.
62. Roland PS, Eaton DA, Gross RD, Wall GM, Conroy PJ, Garadi R, et al. Randomized, placebocontrolled evaluation of Cerumenex and Murine earwax removal products. Arch Otolaryngol Head Neck Surg 2004;130:1175-7.
63. Coppin R, Wicke D, Little P. Managing earwax in primary care: efficacy of self-treatment using a bulb syringe. Br J Gen Pract 2008;58:44-9.
64. Harris PG. A controlled trial of a ceruminolytic in general practice. Clin Trial J 1968;5:1129-33.
65. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1. Chichester: John Wiley & Sons; 2008.
66. Meyers AD, Meyers AD. Managing cerumen impaction. Postgrad Med 1977;62:207-9.
67. Grossan M. Cerumen removal: current challenges. Ear Nose Throat J 1998;77:541-8.
68. Meador JA, Meador JA. Cerumen impaction in the elderly. J Gerontol Nurs 1995;21:43-5.
69. Morrison AW. Silence in court. J Laryngol Otol 1990;104:162-5.
70. Price J. Problems of ear syringing. Practice Nurse 1997:14:126-8.
71. Zivic RC, King S. Cerumen impaction management for clients of all ages. Nurse Pract 1993;18:29-36.
72. Rubin JK. Aural irrigation with water: a potential pathogenic mechanism for inducing malignant external otitis? Ann Otol Rhinol Laryngol 1990;99:117-19.
73. Midani A, Carels I, Marks M, Wall M, Monoyer A, Michaux J-P et al. Safety and efficacy of Sofenz ceruminolytic solution. Ear Nose Throat J 2006;85:87-92.
74. Somerville G. The most effective products available to facilitate ear syringing. Br J Community Nurs 2002;7:94-101.
75. Folmer RL, Shi BY. Chronic tinnitus resulting from cerumen removal procedures. Int Tinnitus J 2004;10:42-6.
76. Ogunleye AO, Awobem AA. Trends of ear syringing at Ibadan, Nigeria. Afr J Med Sci 2004;33:35-7.
77. Kind P, Hardman G, Macran S. UK population norms for EQ-5D. York: University of York, Centre for Health Economics; 1999.
78. Sullivan P, Ghushchyan V. Mapping the EQ-5D index from the SF-12: US general population preferences in a nationally representative sample. Med Decis Making 2006;26:401-9.
79. Barton GR, Bankart J, Davis AC, Summerfield AQ. Comparing utility scores before and after hearingaid provision. Appl Health Econ Res Policy 2004;3:103-5.
80. Uppal S, Jose J, Banks P, Mackay E, Coatesworth AP. Cost-effective analysis of conventional and nurse-led clinics for common otological procedures. J Laryngol Otol 2004;118:189-92.
81. Netten A, Curtis L. Unit costs of health and social care. Canterbury, Kent: PSSRU, University of Kent; 2006.
82. Hussain SSM. Hearing loss in the 4-8 kHz range following tympanic membrane perforation from minor trauma. Clin Otolaryngol 1995;20:211-12.
83. Taylor RS, Paisley S, Davis A.C. Systematic review of the clinical and cost-effectiveness of digital hearing aids. Br J Audiol 2001;35:271-88.
84. Claxton K, Ginnelly L, Sculpher M, Philips Z, Palmer S. A pilot study on the use of decision theory and value of information analysis as part of the NHS Health Technology Assessment programme. Health Technol Assess 2004;8(31).
85. Girling AJ, Freeman G, Gordon J, Poole-Wilson P, Scott DA, Lilford R. Modelling payback from research into the efficacy of left-ventricular devices. Int J Technol Assess Health Care 2007;23:269-77.
86. Philips Z, Claxton K, Palmer S. The half-life of truth: what are appropriate time horizons for research decisions? Medical Decision Making. Med Decis Making 2008;3:287-99.
87. Brennan A, Kharroubi S, O'Hagan A, Chilcott J. Calculating partial expected value of information via Monte Carlo sampling algorithms. Med Decis Making 2007;2:7448-70.
88. Burton MJ, Doree C. Ear drops for the removal of ear wax. Cochrane Database of Systematic Reviews 2009;(1):CD0044326.
89. Egger M, Smith GD, Altman DG. Systematic reviews in health care: meta analysis in context. London: BMJ; 2001
90. Drummond MF, O'Brien BJ, Torrance GW, Stoddart GL. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 1997.
91. Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004;8(36).
92. Eckermann S, Willan AR. Expected value of information and decision making in HTA. Health Econ 2007;16:195-209.
93. Curtis L, Netten A. Unit costs of health and social care. 2006. Canterbury: PSSRU, University of Kent; 2006.
94. Schwartz RH, Rodriguez WJ, Mc Aveney W, Grundfast KM. Cerumen removal: how necessary is it to diagnose acute otitis media. Am J Dis Child 137:1064-65.