Earwax

We thank Weller for his response to our paper¹ and support his view that the focus of management should be the alleviation of symptoms. We also agree that patient satisfaction with bulb treatment might be greater than shown by our data if bulbs were readily available, so avoiding the need to visit a GP practice.

Regarding the choice of wax-softening drops: although we cited the slightly more recent systematic review by Hand² we do not feel that its conclusions differ significantly from the Cochrane review.³ Our statement that ‘it is not known which wax-softening drops are most effective’ is justified by both reviews. With the proviso that, as both reviews agree, there is a dearth of reliable data, we agree with Weller that water may indeed be as effective as sodium bicarbonate. However, as the objective of our study was to assess the effectiveness of bulb syringes, the choice of drops was secondary. Our choice was informed by the current literature to favour a water-based product over the more commonly used olive oil. We did consider water but felt that its use, in this context, was not common practice. Further, as the evidence base is weak, we were concerned that advocating it to colleagues might prove an impediment to recruitment. We therefore made a pragmatic choice of sodium bicarbonate which also had the advantage of being available in standard dropper bottles.