A Study to look at the efficary of Almond Oil

A Studyto look at the efficaryof Almond Oil
and Cerumol Ear Drops in the removalof ear
wax -
MlRRVanlierde, IAM Murray, E Tse
Swruwory
Dr MlRRVanlierde
Mills Memorial Hospital
4720 Haugland Avenue
TERRACE BC V8G 2W7
Canada
Curriculum vitae
Martin Vanlierde was born in Berendi in 1954,
matriculated at Christian Brothers College in
Cape Tou'n and graduated at UCT rvhere he
obtained a BA, BSc and MBChB (1980).
Martin completed his post graduate training in
RSA, and is currently in private specialist
practice in British Columbia, Canada.He is
enrolled for a Master of Medicine degree with
UCT, the thesis based on the use of
tracheostomy in the management of
laryngotracheobronchitis. His interests are also
in head and neck surgery and paediatric
otolaryngologv.
to seethe tympanic membrane if any
pathology is suspectedand for
To cornpnte the fficncy of alru.ondoil ear
insuranceor preemployment medical
d.ropsand. Cerwwol eat,drops in
examinations.',3The common habit
dispensing(ar wax withowt syringing,
of using cotton tipped swabsto
40 rldcrly patients in continuing carr
remove the wax from the external
with excessiye
a.lwzantsof ear wax which
meatus is to be deplored.o'sThis
wnwonted syttnging, wet'egiuen alwond.
regularly causesthi wax to be pushed
oil or Ceruwol iru n randnntised.obsewerfurther into the meatus. therebv
blitcd.fashi,on.Aftt, fwe d.ays,13 out of
making spontaneousexpulsion'
35 enrs (37o/o)in the Cerwruolgr"owp
impossible. Curetting the wax plug is
bad.signafi,cnntredwctionin. the arnount
possibleunder optimum conditions,
of ear wax thus avoid"edsyringing. Snen
including a good light and an
owt of 34 (21o/o)in the nlwond.oil growp
experiencedotolaryngologist but, in
had.sitnilnr red.wction.There is no
turn, may causetraumatic bleeding in
signi.fi,cnntd.ffirence in the reswlts
the ear canal.The most acceotable
betweenthesetwo growps. Przpl,xetwy
commonly usedmethod of removing
preparntiotcsof enr wax solvents,wh'icb
the ear wax is syringing but this, in
nre nine to l5 tatneswtoreexaensiyethan
turn, has its complications of
alrnond or olipeoil ear drooi. havr ncyer
perforation of the rympanic
beensbownin any standaiditrd nial to
membrane, and otitis externa.
be concluritely supetior"than thesesimple,
Facilitation ofear syringing by the
non-toxic and. cheapa.gents.
prior use of ear wax solventsis
routine Dractice.rThe evidenceto
S Afi, Faru Pract 1991; 12: 324-6
substantiatethe value ofthis practice
is lacking. Traditionally, sodium
bicarbonateor almond oil ear droos
were
usedand theseagentswere
I(EYWORDS:
cheap and relatively non-toxic. More
Oils; Ear;Waxes;D-g
recently,.severalproprietary
Evaluation;Syringes
preparauonsconrarmng orgaruc
solvents have been available.There
are sevenofthese prcparations listed
in the current issue of the British
Introduction
National Formulary.6
Ear wax (cerumen) is a mixture of
the secretionofsebaceousand
This study is designedto compare
ceruminous glands in the outer third
two commonly used ear wax solvents,
of the external auditory meatus. It has almond oil and Cemmol in their
a protective function of trapping dust efEcacy to disperse ear wax without
and foreign particles in the sticky
the necessityfor syringing.
secretion.This secretiondries on the
surface of the skin and, with ordinary
chewing movement and migration of
Patientsand Methods
squamousepithelial cells, is expelled.
Occasionally, the wax forms a hard
The ears of a stable population of
plug and blocks the external meatus,
gcriatric patientsin sevencontinuing
causing discomfort, a degree of
care wards, were examined by one
deafness,occasionallytinnitus, and
doctor. Each patient's ear wax was
dizziness.' It is imoortant to be able
assessed
as shown in Table I.
324
S A F a m i l y P r a c t i c eA u g u s r l 9 9 l
SA HuisartsprakrykAugustus1991
... Efficaryof AlmondOil
Table I. Grading of Wax
Amounts
Wa*4'+tq
- Gradir@
Iffi" I
to
ffi
Each patient was reassessedtwo days
after initial assessmentto standardise
the findings. Intraobservervariability
was negligible due to prior self
standardisation.
Patientswho had either a Grade 3 or
Grade 4 amount of wax in either ear
were eligible for the study. In a
randomisedobserver-blindfashion,
Cerumol drops were given to one ear
and almond oil drops given to the
other. Five drops were given twice
daily for five days. Some patients with
excessiveunilateral wax were entered
into the trial. The drops in these
patients were given in the same blind
randomised fashion as above.
Results
One hundred and thirry two patients
and 4l were
were initially assessed
acceptedonto the trial. Thirry had
bilateral excessiver,vax,I I unilateral
wax. One patient developed otitis
externa in the ear given Cerumol ear
drops and rvas withdrawn. Thirry
four ears receivedalmond oil and 35
earswere given Cerumol.
Pretreatmentstandardisation
confirmed there was no significant
difference in the wax findings
between the groups (Table II).
After five days in the Cerumol group,
13 crut of 35 ears (37o/o)improved
their amount of wax grading from
Grade 3 and 4 to Grade 2, thus
removing them from the potential ear
syringing group. In the almond oil
group, sevenout of 34 ears (2lo/o)
improved to Grade 2. There is no
significant difference in the results
betweenthese groups (Table III).
Table III. Grade of Ear Wax
Impaction after Application of
Ear Drops
$,
-r
K':
)
!
"S*ade
2,
%t
'
#*
x; :
wt
A
@*.'
X' :2,304, p(0,05, ie no significant
difference between the 2 groups
The colour or consistencyof the wax
did not appear to have any bearing
Cotton tipped swabsjust push
the wax deeperinto the meatus
making spontaneousexpulsion
impossible
on diminution of the amount of wax.
In sevenCerumol earsand l0
almond oil ears,thc wax consistency
appearedto be softer.
A review ofthe relevant literature
over the last 20 years revealed a
oaucitv of information on this
iubjeci. In L970, Frasercompared
the easeof syringing after olive oil,
Cemmol, Waxsol, Dioctyl and
Xerumenex versus sodium
bicarbonate. Cerumol alone was
lbund to be significantly more
effective than sodium bicarbonate but
not conclusivelysuperior to olive oil
and Waxsol.'A multicentre trial in
1982 found Exterol to be superior to
Cerumol (p(0,00I).8
Our study did not confirm that
Cerumol was significantly better at
Table II. Grade of Ear Wax
avoiding ear syringing than almond
oil. It is interesting to note that the
Impaction Before Application
cost ofsodium bicarbonateear drops
of Ear Drops
is 2p (lOc) per l0 ml, olive oil is 6p
(30c) per 10 ml, almond oil is 8p
'i t^f i
tomf (40c) per L0 ml, Cerumol is 72p
per lI ml, Waxsol is 86p
;:-::::::: (R3,60)
*i4
fl\.ll1 IEKrI :.:,+g
53
(R4,30) per L0ml and Exterol, which
l;.. l
?rq
in
34 * is ureahydrogenperoxide complex
glycerol, is2l4p (RI0,70) per 12ml.
: : : : : : : : : : : : : : : : .:: : : !i,\
, 4. f'l1
In the current economic climate, it
. 3 6 . Rtr . @ t
would appearthat greaterattention
c#t; c"aiil
ii*"',ho'ih"i :t&.
"w -t
325
SA Family PracticeAugust l99l
SA HuisartspraktykAugustusl99l
Efficaryof Almond Oil
should be placcd on the costeffectivenessof the common oractice
of the usc of wax sottencrs.
FaireyA, Freer CB, Machin D. Ear wax and
otitis media in children. Br Med I I985;
29I:387 B.
Wanvick-Broq.n NP. Wax impaction in the
ear. Practitioner 1986; 230: 301.
Acknowledgements
Baxter P. Association between use ofcotton
tipped srvabsand ccrumen plugs. I3r Med J
1983;287: 1260.
Theauthorswouldlibeto thanhProfbssot,
McLtnnan.
C.areof rheEldnly (Jnit at rhr C[ry Hupital,
Ed.inbutgb,Jbr allowing usto wsebispatientsand
Mrs Ann Whittfor rypingth manuscript.
6. British National Fonnulary l9BB; 15: 353.
7. Fraser fG. The efficacv oflvax solvents: in
l'itro studies and a clinical trial. I Laryngol
Otol 1970; 84: 1055-64.
References
l. CarncS. Ear syringing.I3rMcd I 1980;
280 374-6.
8. Fahmy, Whitefield M. Multiccntre clinical
trial of Exterol as a cerumenolytic. Br I Clin
Pract 1982; 36:197 204.
2. SchwartzRlI, RodriguezW], McAv'enyW,
GmndfastKM. Ccrumcn removal:Horv
neccssary
is it to diagnoscacuteotitis
medialAm I I)is Child 1983;137:1064-5.
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on the Register on the South African
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practice in thc field ofgenerai
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