Endoscopic dewaxing in primary care – a replacement for syringing?

Objectives.  To investigate the feasibility and effectiveness of endoscopic dewaxing 1 in primary care as a replacement for syringing or irrigation of the external auditory meatus. Method.  Case control pilot study. Seven practice nurses from General Practices in the Wiltshire area completed a training course in the technique of endoscopic dewaxing. After training the group dewaxed 100 sequential ears using irrigation followed by 100 ears using endoscopic dewaxing. Data on patient feedback, time and difficulty were recorded. To account for the learning curve associated with the technique, the endoscopically dewaxed ears were analysed in two groups, the first 50 performed and the last 50 performed by the nurses. Results.  There was no significant in difference in pain or satisfaction scores between the first 50 endoscopic dewaxes and irrigation ( P  =   0.21, P  =   0.31). The level of satisfaction with the second group of endoscopic dewaxes was 95.5 ( sd  = 42.7) compared to irrigation at 65.5 ( sd  = 28.9) ( P <  0.001). The mean time take to perform irrigation was 10.8 min, very similar to both groups of endoscopic dewaxing (11.8 min and 10.3 min respectively, P  =   0.3) Conclusions.  Endoscopic dewaxing can be successfully introduced into primary care and represents a technique performed under direct vision. It takes a similar length of time and is associated with greater patient satisfaction. It can be effectively performed without prior wax softening and is likely to be safer than irrigation, particularly where there is undiagnosed tympanic membrane pathology. Reference.  1 Pothier D.D. (2006) How we do it: technical note: endoscopic removal of cerumen. Clin. Otolaryngol. 31, 153–155