Cerumen Impaction Removal in General Practices: A Comparison of Approved Standard Products

Abstract

Background Ear irrigation is a commonly used method for removing earwax in general practice. There is no firm evidence if no pre-treatment is as good as pre-treatment with various standard preparations. Aim To assess the effectiveness of no pre-treatment compared to pre-treatment with commercially available cerumenolytics and to assess which preparation is best suited for pre-treatment. Methods This is a pragmatic observational study of patients with cerumen treated from a single GP with 3 different preparations or no preparation prior to standardized ear irrigation. Generalized linear mixed models with logit link function were performed to assess the effectiveness of pre-treatment with different preparations and no pre-treatment. The models were adjusted for age group (<70, ≥70) and sex. Results A total of 168 patients (298 ears, 58 % female, median age 65 years) consulted for obstructive cerumen, some of them several times. The cerumen was successfully removed in 70% (208/298). Comparing any preparation to no preparation (aggregated comparison), the odds ratio for complete clearance was 1.35 (95%confidence interval: 0.69-2.65). Comparing the preparations individually, the odds ratio of the docusate-sodium-based preparation was 1.87 (95% CI: 0.79-4.42) indicating a higher effectiveness. Although, not statistically significant. Ear irrigation was less successful for patients aged ≥ 70 years (OR = 0.48, 95% CI: 0.23-0.98). Conclusions The aggregated comparison indicates a slight trend toward a higher effectiveness of any pre-treatment compared to no pre-treatment. The effect-size of docusate-sodium-based pre-treatment indicates a higher effectiveness of cerumen impaction removal. Nevertheless, superiority could not be shown conclusively according to the statistical significance given the restricted sample size.

Cerumen impaction: Prevalence and associated factors in the United States population

“…Addressing cerumen impaction, especially among older adults has clinical implications for optimizing their hearing thresholds and reducing associated symptoms. 6,8 Routine monitoring and appropriate cerumen cleaning should be offered when necessary.…”

“…However, this report included only adults aged 20–69 years without adolescent or older adult populations. While prior studies have identified several factors associated with a higher burden of cerumen such as older age and individuals with intellectual disabilities, there is currently limited knowledge regarding other demographic or clinical factors that may play a role 7–9 . Similarly, despite hearing loss and tinnitus being frequently cited symptoms of cerumen impaction, the supporting data is not as established.…”

“…While prior studies have identified several factors associated with a higher burden of cerumen such as older age and individuals with intellectual disabilities, there is currently limited knowledge regarding other demographic or clinical factors that may play a role. [7][8][9] Similarly, despite hearing loss and tinnitus being frequently cited symptoms of cerumen impaction, the supporting data is not as established. Investigations into the audiometric impact of cerumen have demonstrated an elevation in pure tone thresholds with increasing levels of EAC occlusion, 7 but the extent of this effect remains disputed as identical levels of occlusion have resulted in anywhere from a 5 to 40 dB hearing loss.…”

Prevalence and associated symptoms of cerumen in adults in Rio Grande do Norte

“…Glands of the outer two thirds of the ear canal produce substances that will form the cerumen (Shokry & Filho, 2017, Meyer et al, 2020, which is a biological fluid rich in saturated and unsaturated fatty acids, long-chain hydrocarbons, cholesterol, alcohol, scalene, ceramides and triglycerides, in addition to exfoliated epithelial cells (Shokry & Filho, 2017, Zivic & King, 1993, Jabor & Amedee, 1997.…”

“…The cerumen is physiologically expelled by a self-cleaning mechanism aided by the jaw, in which it is directed to the ear, taking with it adhered dirt particles and hair strands (Meyer et al, 2020, Gabriel, 2015. However, if this mechanism fails, earwax builds up and can even cause a total blockage of the ear canal.…”