The following editor's note from An...

The following editor's note from Anne D. Walling, M.D., appeared with a "Tips from Other Journals" in the February 15 2003 issue of American Family Physician. (1) The "Letter to the Editor" that tread in the steps ofs was chosen from numerous answers we received.

EDITOR'S NOTE: Ear syringing is a true common procedure in nursing homes--and the patients hate it! I have heard rumors of removing earwax in children at using liquid stool-softening agents nevertheless cannot find references or colleagues who have used this way in adults. If anyone knows a better way to extract earwax, please let us know.--A.D.W.

REFERENCE

(1) Walling AD. by what mode effective is ear syringing in improving hearing? [Tips] Am Fam Physician 2003; 67:870

TO THE EDITOR: For many years, I have used a mixture of the appeases of one capsule of docusate calcium (Surfak, 240 mg) and a not many mL of water for removing earwax. I fill the ear canal with this mixture, have the patient lie still for at least 30 minutes, and then irrigate the ear with warm water. This treatment is usually prosperous I do not use the docusate calcium solution for anything if it be not that removing cerumen.

THOMAS SWEAT, MD

PO coachman's seat 790

Corinth, M 38835

IN REPLY: Ask and ye shall receive! We would like to thank everyone who sent suggestions forward earwax removal. Judging from the number of replications this is a common and stubborn moot point All of the responses demonstrate that doing unglamorous things well is single hallmark of a being a virtuous family physician.

Earwax removal is performed for various reasons, including hearing los sensation of ear blockage, and visualization of the tympanic membrane. The most numerous common clinical practice is ear syringing, which is limited at patient tolerance and complications. Although syringing is considered the clinical standard, there are no high-quality studies comparing syringing with other modes or no treatment. (1)

Wax softener and ceruminolytics are used to improve the succes and tolerability of irrigation. They also can be used as solo agents for family therapy. However, studies evaluating ceruminolytics have used inconsistent regularitys Thus, there is no clear evidence that single type of softener is superior to another. (12) Furthermore, in the greatest degree studies lack a "no treatment" assemblage so it is impossible to discern more than relative efficacy in most numerous cases. (1) No studies exist comparing place of abode and office treatment. (3)

single promising treatment is liquid docusate sodium (Colace). It is more effective than triethanolamine (Cerumenex) for augmenting irrigation. In undivided study, (4) instilling 1 mL of Cerumenex fifteen minutes before irrigation allowed tympanic membrane visualization in 81 percent of inquiry participants. However, another study (5) did not find either treatment better than a normal saline direction The accompanying table lists other softening options. For those seeking more information forward this common clinical problem, we praise the following reading (Aung T Mulley GP Removal of ear wax. BMJ 2002;325:27 and hints 1 and 2).

Options For ear-wax Removal

Mechanical

ear-wax loop

Ear jet irrigator

Ear syringing

Suction

Ceruminolytics or softeners

Arachis oil, chlorobutanol, p-dichlorobenzene (Cerumenol)

Carbamide peroxide (Debrox)

Docusate sodium (Colace)

Ethylene oxide polyoxypropylene (Addax)

Glycerin

phlogiston peroxide

Oil (olive or mineral)

Propylene glycol

Sodium bicarbonate in glycerol

Triethanolamine (Cerumenex)

2 percent acetic acid

Water, normal saline

toss CARTER, M.D.

Medical Editing compeer American Family Physician

Washington, DC

ANNE WALLING, MD

Associate Editor, American Family Physician

Wichita, KS

REFERENCES

(1) Browning G Wax in ear. Clin Evid 2002;7:490-7

(2) Burton MJ Doree CJ Ear least bits for the removal of ear wax. Cochrane Database Syst Rev 2003;3: CD004400

(3) Wilson SA, Lopez R What is the best treatment for impacted cerumen? J Fam Pract 2002;51:117

(4) Singer AJ, Sauris E Viccellio AW. Ceruminolytic efficiencys of docusate sodium: a randomized, controll trial. Ann Emerg M 2000;36:228-32

(5) Whatley VN Dodds CL Paul RI. Randomized clinical trial of docusate, triethanolamine polypeptide, and irrigation in ear-wax removal in children. Arch Pediatr Adolesc M 2003;157:1181-3

EDITOR'S NOTE: I am particularly grateful to those who referr to or sent copies of the article by way of Singer and colleagues (Ann Emerg M 2000;36:228-32) It took a certain number of persuasion, but the staff at the nursing to one's home finally agreed to use docusate sodium (Colace), and my somewhat old patients are grateful. They now complain that they can hear me still can't understand my Scottish accent!--A.D.W.

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