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Am Fam Physician. 2012;85(6):Online

Background: It is estimated that 12 million persons in the United States seek care for earwax buildup each year, and 8 million ear irrigations are performed. Clinical ear irrigation typically is done after ear drops have been used to soften cerumen. Bulb syringes for removing earwax by self-irrigation are available over the counter, which may reduce the need for clinical ear irrigation procedures and associated health care costs. Coppin and colleagues conducted a trial to determine the effectiveness of bulb syringe treatment for earwax buildup.

The Study: Persons with symptomatic, visibly occlusive earwax were recruited from seven family practice clinics in the south of England. A total of 434 persons were assessed for eligibility. Of the 237 participants who enrolled, 118 were allocated to the bulb syringe group and 119 to the control group. Participants in the intervention group received ear drops, a 25-mL bulb syringe, and written instructions for bulb syringe use and reuse. Persons in the control group received an envelope of identical weight, size, and texture, which contained ear drops, and instructions on usual treatment, which involved ear irrigation by a clinic nurse following use of ear drops. Two weeks after randomization, persons in both groups returned for evaluation. A clinic nurse performed ear irrigation on all persons who continued to have occlusive earwax.

A follow-up study included a two-year review period of participant records for problems with earwax, its treatment, and related hospital referrals. Both groups were well matched in age, sex, symptoms, and percentages of persons with right and left complete ear occlusion.

Results: During the two-year follow-up, more persons in the control group returned to the clinic with episodes of earwax buildup (85 persons in the control group versus 70 persons in the bulb syringe group; 73 versus 60 percent, respectively). In addition, the mean number of consultations for earwax buildup was greater in the control group than in the group receiving bulb syringes (1.15 and 0.64 consultations, respectively). The mean number of irrigation procedures also was greater in the control group (0.91) than in the bulb syringe group (0.46).

Conclusion: In persons who have previously sought clearance of occlusive earwax, the need for clinical ear irrigation is significantly reduced by self-irrigation using a bulb syringe. Although there have been concerns for perforation of the tympanic membrane associated with irrigation, the authors refer to a systematic review that suggests ear irrigation with bulb syringe is reasonably safe.

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