title: The effectiveness of topical preparations for the treatment of earwax: a systematic review.
abstract: BACKGROUND
  Earwax is a common problem in both primary and secondary care. There is uncertainty as to the most effective topical treatment.
  
  
  OBJECTIVE
  To assess the evidence concerning the efficacy of topical preparations used for treating earwax.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Searching for randomised controlled trials (RCTs) of relevant studies. Classification of preparations into three groups, enabling pooling of data and meta-analysis.
  
  
  RESULTS
  Of the 18 RCTs included in the review, four were judged to be of high quality. Fifteen preparations including saline and plain water were studied. Oil-based and water-based preparations were equally effective at clearing earwax without syringing (odds ratio [OR] = 0.9, 95% confidence interval [CI] = 0.4 to 2.3) and facilitating successful syringing (OR = 1.0, 95% CI = 0.6 to 1.6). A non-water-, non-oil-based preparation appeared more effective than an oil-based preparation at both clearing earwax without syringing, and facilitating successful syringing. Immediate syringing after application of a preparation may be as effective as using eardrops for several days and delaying syringing.
  
  
  CONCLUSIONS
  On current evidence, there is little to choose between water-based and oil-based preparations; non-water-, non-oil-based preparations appear promising at both clearing earwax and facilitating successful syringing, but further large trials are needed. Although immediate ear syringing is effective and convenient for patients, it may be less cost-effective than using eardrops and perhaps avoiding syringing. Most of the evidence regarding such a common and time-consuming problem is not of high quality.
authors.affiliation: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK. c.hand@uea.ac.uk
authors.forename: Christopher
authors.initials: C
authors.lastname: Hand
authors.forename: Ian
authors.initials: I
authors.lastname: Harvey
mesh_terms: D000287:Administration, Topical; D002571:Cerumen / Q000187:drug effects; D003362:Cost-Benefit Analysis; D006801:Humans; D009821:Oils / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013594:Syringes; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome; D014867:Water
chemical_list: D009821:Oils; D014867:Water