Vanlierde 1991.

Methods	Double‐blind, 2‐arm, parallel‐group, randomised controlled trial, with active comparator (no placebo) and 5 days duration of treatment
Participants	Setting: multicentre, 7 continuing care wards Sample size: Number randomised: 41 participants; 71 ears Number completed: 40 participants, 69 ears Participant baseline characteristics: Age: not stated (elderly) Gender: not stated Inclusion criteria: stable population of geriatric patients, must have grade 3 or 4 on a wax occlusion scale of 0 to 4 (0 being no wax) Exclusion criteria: none mentioned
Interventions	Intervention group 1 (n = unclear participants; 34 ears): almond oil, 5 drops, twice daily, for 5 days Control group 2 (n = unclear participants; 35 ears): chlorobutanol, arachis oil and dichlorobenzene (Cerumol), 5 drops, twice daily, for 5 days Use of additional interventions: unstated
Outcomes	Primary outcomes: Reduction in wax from grade 3 or 4 to grade 2 Secondary outcomes: Colour and consistency of the wax Timing of measurements: After 5 days of ear drops
Funding sources	No information provided
Declarations of interest	No information provided
Notes	One patient developed otitis externa after using chlorobutanol, arachis oil and dichlorobenzene (Cerumol) and was withdrawn from the study
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "in a randomised observer‐blind fashion" Comment: insufficient information regarding methods used
Allocation concealment (selection bias)	High risk	Comment: not mentioned
Blinding of participants and personnel (performance bias) All outcomes	High risk	Quote: "intraobserver variability was negligible due to prior self standardisation"
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Quote: "in a randomised observer‐blind fashion"
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: all participants were accounted for
Selective reporting (reporting bias)	Unclear risk	Comment: unclear distinction between planned methods and results reported
Other bias	Low risk	Comment: no further sources of bias identified