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
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Slide1
BestBETsUse of olive oil for ear wax
Nick Jones & Kat Young
Slide2PopulationAdults (>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
Slide3In
{an adult with symptomatic ear wax}
are {olive oil ear drops} best at {removing wax and facilitating syringing} ?Three part question
Slide4A 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
Slide5PubMed, Embase & Medline search using strategy:
[
exp ear wax OR cerumen] AND [olive oil]LIMIT to human and English languageSearch strategy
Slide6Results
26 papers
3 systematic reviews or meta-analysis
2 relevant RCTs
21 irrelevant
or in vitro
1 controlled clinical trial
??
Eekhof
paper
Slide7Author,
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
Slide8Author,
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
Slide9Author,
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
Slide10Author,
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
Slide11The 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
Slide12There 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