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BestBETs Use of olive oil for ear wax BestBETs Use of olive oil for ear wax

BestBETs Use of olive oil for ear wax - PowerPoint Presentation

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Uploaded On 2022-06-11

BestBETs Use of olive oil for ear wax - PPT Presentation

Nick Jones amp Kat Young P opulation Adults gt18 yrs presenting with symptomatic ear wax I ntervention Use of olive oil drops C omparator Use of alternative ear wax solvent or no treatment ID: 916858

oil wax ear olive wax oil olive ear syringing amp results study randomised significant control trial patients intervention attempts

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Slide1

BestBETsUse of olive oil for ear wax

Nick Jones & Kat Young

Slide2

PopulationAdults (>18

yrs

) presenting with symptomatic ear waxInterventionUse of olive oil dropsComparatorUse of alternative ear wax solvent or no treatmentOutcomeRemoval of ear wax, with or without syringing

Forming a clinical question

Slide3

In

{an adult with symptomatic ear wax}

are {olive oil ear drops} best at {removing wax and facilitating syringing} ?Three part question

Slide4

A 40 year old man presents to his GP with a sensation of bilateral blocked hearing, tinnitus and itching. Examination reveals hard wax obscuring the auditory canal and tympanic membrane.

The gentleman asks if olive oil drops are the best first option and whether they need to be used in conjunction with syringing to be effective?

Clinical scenario

Slide5

PubMed, Embase & Medline search using strategy:

[

exp ear wax OR cerumen] AND [olive oil]LIMIT to human and English languageSearch strategy

Slide6

Results

26 papers

3 systematic reviews or meta-analysis

2 relevant RCTs

21 irrelevant

or in vitro

1 controlled clinical trial

??

Eekhof

paper

Slide7

Author,

date & county

Chaout De Saintonage & Johnstone. 1973, UKPatient group67 patients presenting to secondary care clinic with impacted ear wax.

Randomised

to treatment with olive oil (35) or

triethanolamine

polypeptide (TP) (32) with subsequent syringing for all patients.

Study level

Randomised

controlled trial.

Outcomes

Amount of wax removed, measure of occlusion of TM & volume

of water needed for irrigation & removal.

Key results

States no significant

difference in degree of occlusion or amount of wax removed, but no p values and in 4/35 of those with olive oil negligible removal vs 0/32 in TP group. Significantly smaller water volume required in TP group (p<0.05).Study weaknesses

Participant groups and concealment process not described so risk of selection bias. Assessors not blinded to treatment. Amount of water used estimated by assessor, significant risk of bias. Relatively small sample size, no power calculations.

Results

Slide8

Author,

date & county

Fraser et al. 1990, UKPatient group124 geriatric patients from 6 secondary care sites with bilateral hard ear wax occluding the TM. One ear treated, other used as control with sodium bicarbonate for each patient. Various substances used. 25 patients randomised to olive oil.

Study level

Multi-

centre

randomised

control trial.

Outcomes

Ease of syringing, assessment of

wax removed, frequency of syringing.

Key results

No significant improvement with olive

oil for either ease or frequency of syringing. Olive oil showed lowest percentage of broken up wax (16%) if the different

cerumenolytics used.Study weaknesses

Subjective measures of ease of syringing, although assessor blinded as to intervention. Baseline amount of ear wax not recorded. Relatively small sample sizes without power calculations.

Results

Slide9

Author,

date & county

Hinchcliffe. 1995, UK.Patient group185 RAF personal with obscured TM due to hard wax in one or both ears. Participants allocated to one of four treatment arms including olive oil with a further control arm. 37 participants in each arm.

Study level

Controlled clinical trial.

Outcomes

Number of times 5 minutes of subsequent syringing

was not successful at clearing meatus after intervention. Number of participants with significant subsequent discomfort.

Key results

Olive oil the only intervention statistically better than control, above sodium bicarbonate,

cerumol

or hydrogen peroxide.

Equally few adverse events as other interventions.

Study weaknesses

Baseline characteristics

of participants not included, relatively small sample size without power calculations.

Results

Slide10

Author,

date & county

Eekhof et al. 2001, Netherlands.Patient group42 patients (59 ears) presenting to primary care with persistent ear wax (defined as persisting after 5 attempts at syringing). Participants allocated by year of birth to have warm water instilled for 15 mins (n=22) or olive oil drops nightly for 3 days (n=20).

Study level

Quasi-

randomised

control trial

Outcomes

Number of syringing attempts required

post intervention to clear ear wax. (Recorded as 6 after 5 failed attempts).

Key results

No

statistically significant difference in number of syringe attempts required (water 3.0 vs oil 2.4). 1 patient in both groups had 5 further failed attempts.

Study weaknesses

Assessors

not blinded as to intervention, randomisation

process not random, potential for selection bias. Small sample size.Results

Slide11

The evidence for the use of olive oil is weak and some of the in vitro studies suggest that it is ineffective alone in cerumenolysis.

It does however seem to be equally effective to other topical solvents in providing a slight advantage over no treatment in facilitating successful syringing.

There is a lack of any recent, well-designed, large scale randomised control trials in this area, a point recognised by the three previous systematic reviews. Conclusion

Slide12

There is no evidence that olive oil offers a significant benefit over other topical treatments for ear wax but given its safety and cost is a reasonable first line treatment, particularly if used in conjunction with subsequent syringing.

Bottom line