Appendix 1.
Details of included studies undertaken in primary care settings
| Study details | Comparison | Key measure (s) | Statistical significance |
|---|---|---|---|
| Audax® | |||
| Lyndon et al,2 | |||
| RCT | 1. Audax® (n = 19) | Degree of impaction: none, mild, moderate, or severe | Not statistically significant (no P-value reported) |
| Age, mean (range) years: 52 (19–86) overall | |||
| Sex, M:F for all patients: 19:17 | 2. Earex® (n = 17) | Ease of syringing: not required, easy, difficult, or impossible | Statistically significant in favour of Audax® (P<0.005) |
| Follow-up: 5 days | |||
| Cerumol® | |||
| Fahmy and Whitefield,3 | |||
| CCT | 1. Cerumol® (ears = 157) | Wax dispersal without syringing | Statistically significant in favour of Exterol® (P<0.001) |
| Age: not reported | |||
| Sex: not reported | 2. Exterol® (ears = 129) | ||
| Follow-up: 1 week | |||
| Jaffé and Grimshaw,4 | |||
| RCT | 1. Cerumol® (n = 53) | Number of people needing syringing | Statistically significant in favour of Otocerol® (P = 0.05) |
| Baseline characteristics: | |||
| Age distribution (Group 1:Group 2): | 2. Otocerol® (n = 53) | ||
| 0–9 years: 0:1 | |||
| 10–19 years: 5:1 | |||
| 20–59 years: 31:35 | |||
| 60–89 years: 17:16 | |||
| Sex, M:F: | |||
| 1. 32:21 | |||
| 2. 25:28 | |||
| Follow-up: patients asked to revisit GP after three instillations | |||
| General Practitioner Research Group,5 | |||
| RCT | 1. Waxsol® (n = 47) | Volume of water for syringing | Not reported |
| Age groups, % of all patients: | |||
| 10–30 years, 27 | 2. Cerumol® (n = 60) | Ease of wax removal | Not reported |
| 31–50 years, 34 | |||
| 51–70 years, 31 | |||
| 71 years and over, 8 | |||
| Sex: not reported | |||
| Follow-up: immediate | |||
| Dummer et al,6 | |||
| RCT | 1. Audax® (n = 27) | Amount, colour, and consistency of wax | Not reported |
| Age, mean years: | |||
| 1. 51 | 2. Cerumol® (n = 23) | ||
| 2. 55 | |||
| Sex, M:F: | |||
| 1. 18:9 | |||
| 2. 14:9 | |||
| Follow-up: median number of days between visits 1 and 2 was 4 days (range 3–7 days) | |||
| Triethanolamine polypeptide | |||
| Singer et al,7 | |||
| RCT | 1. DS (n = 27) | TM visualisation: complete or incomplete | Not statistically significant |
| Age, mean years (SD): | |||
| 1. 38.7 (30.7) | 2. TP (n = 23) | ||
| 2. 46.1 (29.1) | |||
| Sex, M:F (%): | |||
| 1. 16 (59):11 (41) | |||
| 2. 16 (70):7 (30) | |||
| Follow-up: immediate | |||
| Meehan et al,8 | |||
| RCT | 1. DS (n = 15) | TM visualisation: complete, partial, clear | Not reported |
| Age, mean years: 4.6 overall | |||
| Sex, M:F overall: 24:24 | 2. TP (n = 17) | ||
| Follow-up: immediate | |||
| Also saline alone group (n = 16) | |||
| Whatley et al,9 | |||
| RCT | 1. DS (n = 35) | TM visualisation: complete | Not reported |
| Age, mean (SD): | |||
| 1. 36.4 (19.1) monthsa | 2. TP (n = 30) | ||
| 2. 30.9 (15.2) months | |||
| Sex, M:F (%): | Also saline alone group (n = 28) | ||
| 1. 14:20 (41:59) | |||
| 2. 13:17 (43:57) | |||
| Follow-up: immediate | |||
| Amjad and Scheer,10 | |||
| RCT | 1. TP (n = 40) | Degrees of wax removal | Not reported |
| Age: not reported | |||
| Sex: not reported | 2. Carbamide peroxide (n = 40) | ||
| Follow-up: immediate | |||
| Sodium bicarbonate preparations | |||
| Carr and Smith,11 | |||
| RCT | 1. Aqueous sodium bicarbonate (n = 35) | Mean change in degree of cerumen | Not statistically significant (no P-value reported) |
| Age, mean years for all: | |||
| 27.0 | |||
| 25.3 | 2. Aqueous acetic acid (n = 34) | ||
| Age, mean years for children: | |||
| 1. 8.7 | |||
| 2. 7.26 | |||
| Sex: not reported | |||
| Follow-up: 14 days | |||
| Dioctyl-medo | |||
| General Practitioner Research Group,12 | |||
| RCT | 1. Dioctyl-medo (n = 77) | Volume of water for syringing | Not reported |
| Age range, overall, years | |||
| M: 31–50 | 2. Oil-base alone (n = 73) | Ease of wax removal | |
| F: 51–70 | |||
| Sex, all patients, M:F 1.3:1 | |||
| Follow-up: immediate | |||
| Burgess,13 | |||
| CCT | 1. Dioctyl-medo (n = 33 ears) | Ease of removing wax | Not reported |
| Age range, years: 18–75 overall | |||
| Sex, M:F for all patients: 32:18 | 2. Maize oil capsules (n = 41 ears) | ||
| Follow-up: 2–7 days | |||
| Water | |||
| Eekhof et al,14 | |||
| RCT | |||
| Age, mean years (SD): 51 (16) overall | 1. Water (n = 22) | Mean number of syringing attempts | Not statistically significant (P = 0.18) |
| Sex, M:F overall: 20:22 | |||
| Follow-up: immediate for water group but 3 days for oil group | 2. Self-administered oil (n = 20) | ||
| Pavlidis and Pickering,15 | |||
| RCT | 1. Wet syringing (n = 22 ears) | Mean number of syringing attempts | Not tested |
| Age, mean years (SD): | |||
| 1. 63 (8) | 2. Dry syringing (n = 17 ears) | ||
| 2. 65 (20) | |||
| Sex, M:F (%): | |||
| 1. 15 (68):7 (32) | |||
| 2. 11 (65):6 (35) | |||
| Follow-up: immediate | |||
a
One participant discontinued. CCT = controlled clinical trial. DS = docusate sodium. F = female. M = male. RCT = randomised controlled trial.
SD = standard deviation. TM = tympanic membrane. TP = triethanolamine polypeptide.