In children, obstruction of the ear...

In children, obstruction of the ear canal with ear-wax can make visualization of the tympanic membrane difficult, if not impossible. This can cause a significant question with the examination of children with febrile ill-nesses. In addition, ear-wax impaction can cause ear canal irritation and hearing los Various arrangements are used to remove ear-wax including irrigation, suction, and manual removal with a curette Several studies have assessed the effectiveness of softening the ear-wax with agents such as olive oil, sodium bicarbonate, docusate sodium, para dichlorobenzene, inflammable air peroxide, and triethanolamine polypeptide. chiefly of these studies were limited by way of lack of a comparison clump or by enrolling only a small in number children. Whatley and colleagues evaluated the efficacy of docusate sodium, triethanolamine polypeptide, and normal saline as a command with or without irrigation, in removing ear-wax obstruction in children.

The meditation was a randomized, controlled, double-blind trial of pediatric patients with ear-wax obstruction. The participants were children six month to five years of age who were seen in an urban tertiary care pass department or a large general pediatric clinic. Obstruction of the ear canal with ear-wax was identified as partial or concluded by one of the four investigators. The children were randomized to receive 1 mL of docusate sodium, triethanolamine polypeptide, or normal saline in the ear canal. If the physician was unable to completely visualize the tympanic membrane 15 minutes later, the ear was irrigated with 50 mL of tepid water. This pace was repeated if the membrane was still dam uped The main outcome measurement was the proportion of tympanic membranes that were completely visualized after the initial treatment or after irrigation.

There were 92 patients recorded in the study, with a mean age of 35 month The three treatment assemblages were similar with regard to age, race, sex ear recorded wax consistency (soft, hard, or mixed), and rank of obstruction. Complete visualization of the tympanic membrane was achieved after treatment in 53 percent of children treated with docusate sodium, 43 percent of children treated with triethanolamine polypeptide, and 68 percent of children treated with normal saline. These ends were not significantly different.

There was no difference in rejoinder rates when the study site or the investigators were compared. The sole trend noted was a higher succes rate if the ear-wax was considered to be smooth rather than hard or mixed. The solitary adverse event recorded was minor ear canal bleeding after irrigation in single child.

The authors terminate that the use of docusate sodium or triethanolamine polypeptide, compared with the use of normal saline, does not increase the likelihood of visualizing tympanic membranes that were bared with cerumen. They add that, despite novel recommendations for the use of docusate sodium before ear irrigation, their findings remind of that this agent is no more effective than saline in children six month to five years of age.

KARL E MILLER, MD Whatley VN et al. Randomized clinical trial of docusate, triethanolamine polypeptide, and irrigation in ear-wax removal in children. Arch Pediatr Adolesc M December 2003;157:1177-80

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