Randomized trial of bulb syringes for earwax: impact on health service utilization

Coppin, Richard, Wicke, Dorothy and Little, Paul (2011) Randomized trial of bulb syringes for earwax: impact on health service utilization. Annals of Family Medicine, 9, 110-114. (doi:10.1370/afm.1229). (PMID:21403136)

Abstract

Purpose: Bulb syringes can be used for the self-clearance of earwax and, in the short term, appear effective. We compared the long-term effectiveness of self-irrigation using a bulb syringe with routine care in United Kingdom (UK) family practice clinics where irrigating ears to remove wax is a common procedure.

Methods: We assessed the impact on health service utilization as a follow-up to a single-blind, randomized, controlled trial of 237 patients attending 7 UK family practice clinics with symptomatic, occluding earwax who were randomized to an intervention group (ear drops, bulb syringe, instructions on its use and reuse) or a control group (ear drops, then clinic irrigation). After 2 years, a retrospective notes search for earwax-related consultations was carried out. We used an intention-to-treat analysis to assess differences in dichotomous outcomes between groups.

Results: In the 2-year trial follow-up, more control group patients returned with episodes of earwax: 85 of 117 (73%) control vs 70 of 117 (60%) intervention, 2=4.30; P = .038; risk ratio 1.21 (95% CI, 1.01–1.37). The numbers of consultations amounted to 1.15 (control) vs 0.64 (intervention) (incidence rate ratio 1.79; 95% CI, 1.05–3.04, P = .032), ie, a difference of 0.50 consultations, thus saving a consultation on average for every 2 people.

Conclusion: For patients who have not already tried bulb syringes, self-irrigation using a bulb syringe significantly reduces subsequent demand for ear irrigation by health professionals. Advocating the initial use of bulb syringes could reduce demand for ear irrigation in family practice clinics.

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