Effectiveness of ear syringing in general practice: A randomised controlled trial and patients' experiences

Background: Ear syringing is a common procedure performed for a variety of symptoms in primary care. Reports of its effectiveness vary considerably and no randomised controlled trials (RCTs) have been performed. Aim: To estimate the effect of ear syringing on hearing thresholds, and on symptoms leading to ear syringing in general practice. Design of study: Randomised single-blind controlled trial. Before-and-after self-assessments of symptoms. Setting: Patients from three general practices in the Bristol area attending twice-weekly clinics dedicated to ear syringing over a 12-week period. Method: Patients were randomly assigned to have their hearing tested before and after ear syringing, or twice before ear syringing. Changes in hearing threshold were measured by pure tone audiometry (PTA). All patients completed self-assessment forms of symptoms using Likert scales before, and one week after, ear syringing. Results: Hearing threshold improved by 10 dB or more in 34% (95% confidence interval [CI] = 21% to 47%) of the intervention group and 1.6% of control group (number needed to treat = 3.1, 95% CI = 2.2 to 5.2, P<0.001). The levels of improvement in the intervention group ranged between 15 dB and 36 dB. The symptoms that most commonly improved included hearing on the phone, pain, a feeling of blocked ears, and hearing one-to-one. There was a strong relationship between the change in thresholds, as measured using PTA, and self-reports of hearing improvement. Secondary analysis was unable to identify predictors of objectively measured improvement. Conclusion: Ear syringing improved hearing threshold in a substantial proportion of patients. An even larger proportion reported an improvement in symptoms. It was not possible to predict which patients would benefit.