Table.
GRADE Evaluation of interventions for Ear wax.
| Important outcomes | Treatment success | ||||||||
| Studies (Participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of methods to remove ear wax? | |||||||||
| 1 (26) | Treatment success | Ear irrigation with prior water instillation versus ear irrigation without prior water instillation | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, lack of blinding, subjective assessment of outcome, and manual irrigation |
| 1 (100) | Treatment success | Endoscopic vision versus microscopic vision to assist mechanical dewaxing | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results, and blinding flaws |
| 1 (45) | Treatment success | Water-based wax softeners prior to irrigation versus no treatment | 4 | –3 | 0 | –1 | +2 | Low | Quality points deducted for sparse data, incomplete reporting of results, and weak methods; effect size points added for OR >5; directness point deducted for non-standard syringe method |
| at least 5 (at least 256) | Treatment success | Water-based wax softeners prior to irrigation versus saline | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for weak methods and incomplete reporting of results |
| 5 (523) | Treatment success | Water-based wax softeners versus oil-based wax softeners prior to irrigation | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for weak methods |
| 4 (190) | Treatment success | Water-based wax softeners versus each other prior to irrigation | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and weak methods |
| 1 (60) | Treatment success | Oil-based wax softeners versus saline prior to irrigation | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and weak methods |
| 4 (381) | Treatment success | Oil-based wax softeners versus each other prior to irrigation | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for incomplete reporting of results and weak methods |
| 1 (unclear) | Treatment success | Non-water, non-oil based wax softeners versus water-based preparations prior to irrigation | 4 | –3 | 0 | –1 | 2 | Low | Quality points deducted for sparse data, incomplete reporting of results, and weak methods; directness point deducted for unclear population/baseline; effect size points added for OR >5 |
| 1 (116) | Treatment success | Wax softeners alone versus wax softeners plus irrigation | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results, and for possible bias |
| 1 (97) | Treatment success | Wax softeners versus no treatment | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results, and weak methods |
| 1 (97) | Treatment success | Wax softeners versus sterile water | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, incomplete reporting of results, and weak methods |
| 2 (91) | Treatment success | Water-based wax softener versus saline | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and weak methods |
| 4 (unclear) | Treatment success | Water-based wax softeners versus each other | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for incomplete reporting of results and weak methods |
| 2 (88) | Treatment success | Non-water, non-oil wax softener versus oil-based wax softener | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, weak methods, and incomplete reporting of results |
| 1 (106) | Treatment success | Oil-based wax softeners versus each other | 4 | –3 | 0 | 0 | 1 | Low | Quality points deducted for sparse data, incomplete reporting of results, and weak methods; effect size point added for OR >2 |
We initially allocate 4 points to evidence from RCTs, and 2 points to evidence from observational studies. To attain the final GRADE score for a given comparison, points are deducted or added from this initial score based on preset criteria relating to the categories of quality, directness, consistency, and effect size. Quality: based on issues affecting methodological rigour (e.g., incomplete reporting of results, quasi-randomisation, sparse data [<200 people in the analysis]). Consistency: based on similarity of results across studies. Directness: based on generalisability of population or outcomes. Effect size: based on magnitude of effect as measured by statistics such as relative risk, odds ratio, or hazard ratio.