Family Practice Vol. 21, No. 4, 413-414
Family Practice Vol. 21, No. 4 © Oxford University Press 2004, all rights reserved.
Management of earwax in primary care—postal survey of UK GPs and practice nurses
a The Surgery, Station Road, Overton, Hants RG25 3DZ, b Research and Development Support Unit, General Hospital, Southampton SO16 6YD and c Primary Medical Care, University of Southampton SO16 5ST, UK
E-mail: overtonsurgery{at}dial.pipex.com
Received 15 July 2003; Revised 19 November 2003; Accepted 10 March 2004.
Coppin R, Wicke D, Mehta R and Little P. Management of earwax in primary care—postal survey of UK GPs and practice nurses. Family Practice 2004; 21: 413–414.
Keywords. Ear wax management, postal survey, primary care.
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Introduction |
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The management of symptomatic ear wax is a frequent demand on general practice,1 but is under-researched.2 Since an earlier survey of GPs in Scotland,3 there has been an increase in the number of practice nurses (PNs) in the UK4 and there seems to have been a trend away from traditional metal syringes towards electronic ear irrigators. As part of a project to improve ear wax management, we decided to survey a sample of GPs and PNs to explore current pathways of care.
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Methods |
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We developed a short, self-administered, mostly forced-choice, questionnaire and piloted it on a small group of GPs and PNs. Based on data from the previous survey,3 to detect a difference of 12% between GPs syringing and PNs syringing and assuming a 70% response rate, we calculated that for 80% power and a 5% two-sided significance level, a sample of 206 GPs and 206 PNs would need to be approached. In March 2002, having obtained ethical approval, we posted the questionnaire to a random sample comprising 205 GPs and 203 PNs identified from the UK Department of Health NHS GP and practice database. We sent up to two reminders. Sixteen addressees were not contactable, leaving a study sample of 392, from which we received 295 responses (75%). The response rates for GPs and PNs were 64 and 87%, respectively. Not all questions were completed by all respondents. Data were analysed using SPSS-11. The 95% confidence intervals (CIs) are shown. A subsample of 50 responders were re-sent the questionnaire, 32 responded and measures of agreement were calculated.5
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Results |
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The responses are shown in Table 1. Of respondents, 124 (42%) were GPs. Seventy-percent of GPs and 27% of PNs were full time, and 35% of GPs and 98% of PNs were female. The mean age of both professional groups was in the 40–49 year decile.
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The initial assessment of patients presenting with symptoms suggestive of ear wax was ‘mostly or always’ carried out by GPs, PNs and community nurses in 50, 46 and 8% of respondents' practices, respectively. In 37% of practices, GPs ‘mostly or always’ inspected ears prior to syringing as a matter of policy. Responsibility for syringing itself was predominantly delegated to nurses, with GPs, PNs and community nurses ‘mostly or always’ undertaking syringing in 6, 86 and 28 of practices, respectively. In only 5% of practices did GPs ‘mostly or always’ have to inspect ears after syringing as a policy.
Of respondents, 11% (7–15) of GPs and 6% (3–9) of PNs were not involved in managing earwax themselves. Of the remaining respondents, 97% ‘mostly or always’ advised the use of softening drops prior to syringing. Of drops for ear wax, olive oil was the first choice of 48% (38–58) and 76% (69–83) of GPs and PNs, respectively, compared with Cerumol® 22% (14–30) and 10% (5–15), and sodium bicarbonate 18% (11–27) and 8% (4–12). The mean frequency and duration of treatment were 2.19 (2.18–2.20) times daily and 5.5 (5–6) days, respectively.
Of techniques used to remove wax, a traditional piston syringe was ‘mostly or always’ used by 28 and 15% of GPs and PNs, respectively, and an electronic irrigator by 72 and 90%, respectively. When asked to respond to the statement that electronic irrigators are less effective than a traditional syringe, 46% of GPs compared with 78% of PNs disagreed. Although 61% of PNs agreed that syringing was a worthwhile use of their time, only 26% of GPs agreed. However, 84% of all respondents would like to encourage more self-help.
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Discussion |
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These data show that managing ear wax is increasingly the responsibility of PNs. Comparing our data with the earlier survey,3 many fewer GPs ‘always’ syringe ears (6 versus 19%) and the task is more often ‘routinely’ undertaken by PNs (86 versus 27%). The preference for ear drops has not changed, with olive oil still the first choice—despite no evidence for its effectiveness.
Electronic ear irrigators are now more popular than traditional ear-syringes, particularly with PNs, but, surprisingly, many GPs remain to be convinced of their effectiveness. Unlike PNs, most GPs feel that syringing is not a good use of their time. In many countries, patients can purchase plastic bulb syringes with which to irrigate their own ears. Might this be a way to reduce treatment room costs?
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References |
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1 Hibble A. Practice nurse workload before and after the introduction of the 1990 contract for general practitioners. Br J Gen Pract 1995; 45: 35–37.[Web of Science][Medline]
2 Browning GG. Wax in ear. Clin Evidence 2002; 7: 490–497.
3 Sharp JF, Wilson JA, Ross L, Barr-Hamilton RM. Ear wax removal: a survey of current practice. Br Med J 1990; 301: 1251–1253.
4 Royal College of General Practitioners. Profile of UK General Practitioners. Information Sheet 1. London: Royal College of General Practitioners; 2001.
5 Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures. Br Med J 1992; 304: 1491–1494.
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