title: Randomized trial of bulb syringes for earwax: impact on health service utilization.
abstract: OBJECTIVE
  Bulb syringes can be used for the self-clearance of earwax and, in the short term, appear effective. We compared the long-term effectiveness of self-irrigation using a bulb syringe with routine care in United Kingdom (UK) family practice clinics where irrigating ears to remove wax is a common procedure.
  
  
  METHODS
  We assessed the impact on health service utilization as a follow-up to a single-blind, randomized, controlled trial of 237 patients attending 7 UK family practice clinics with symptomatic, occluding earwax who were randomized to an intervention group (ear drops, bulb syringe, instructions on its use and reuse) or a control group (ear drops, then clinic irrigation). After 2 years, a retrospective notes search for earwax-related consultations was carried out. We used an intention-to-treat analysis to assess differences in dichotomous outcomes between groups.
  
  
  RESULTS
  In the 2-year trial follow-up, more control group patients returned with episodes of earwax: 85 of 117 (73%) control vs 70 of 117 (60%) intervention, χ(2)=4.30; P = .038; risk ratio 1.21 (95% CI, 1.01-1.37). The numbers of consultations amounted to 1.15 (control) vs 0.64 (intervention) (incidence rate ratio 1.79; 95% CI, 1.05-3.04, P = .032), ie, a difference of 0.50 consultations, thus saving a consultation on average for every 2 people.
  
  
  CONCLUSIONS
  For patients who have not already tried bulb syringes, self-irrigation using a bulb syringe significantly reduces subsequent demand for ear irrigation by health professionals. Advocating the initial use of bulb syringes could reduce demand for ear irrigation in family practice clinics.
authors.affiliation: Research & Development Office, The Surgery, Overton, Hampshire, United Kingdom. richard.coppin@nhs.net
authors.forename: Richard
authors.initials: R
authors.lastname: Coppin
authors.forename: Dorothy
authors.initials: D
authors.lastname: Wicke
authors.forename: Paul
authors.initials: P
authors.lastname: Little
mesh_terms: D002571:Cerumen; D004424:Ear Canal; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000295:instrumentation / Q000379:methods*; D013594:Syringes / Q000706:statistics & numerical data*