Ear wax removal: Help patients help themselves
Do-it-yourself ear wax removal is safe and simple—and a timesaver for patients as well as physicians.
WHAT’S NEW: Do-it-yourself wax removal is now evidence-based
The American Academy of Otolaryngology-Head and Neck Surgery Foundation’s 2008 clinical practice guideline—based primarily on expert opinion—recommends clinician irrigation only, due to a lack of quality evidence.3
This RCT is the first to provide evidence that some patients do not need to spend time (or money) on a medical visit for ear wax irrigation. The fact that patients who were given bulb syringes had fewer visits, not only for the initial wax removal but also for subsequent episodes of cerumen impaction, suggests that they were self-treating at home without an increase in adverse effects.
CAVEATS: Home irrigation is not for every patient
This intervention cannot be extrapolated to young children or to others who are unable to perform self-irrigation. It is possible that if a patient self-irrigates without prior visualization by a clinician, a contraindication such as ruptured tympanic membrane or active infection could be present.
This study was performed in England, where bulb syringes are not readily available. It is possible that this intervention may be less effective at avoiding cerumen-related office visits in the United States, especially if patients are already using bulb syringes for this purpose. Finally, we note that 60% of the patients in the home irrigation group did return for a visit for cerumen removal during the 2-year follow-up, so home irrigation did not entirely replace office irrigation.
CHALLENGES TO IMPLEMENTATION: Getting buy-in from patients
The greatest challenge to implementation might be convincing patients that they can safely perform self-irrigation at home. This may require written patient instructions, preferably with illustrations. The steps will need to be written clearly and include details such as recommended ear wax softeners, water temperature, use of peroxide (or not), warning symptoms, and when to contact a physician.
A healthy physician-patient relationship, and perhaps, giving patients the bulb syringe and instructions in using it before they leave the clinic, will help to overcome patient hesitancy. Physician inertia may also be a problem, but it should be easy to put this new information into practice once provider resistance is overcome.
Acknowledgement
The PURLs Surveillance System is supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
