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

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.