A comparison of endoscopic and microscopic removal of wax: a randomised clinical trial

Abstract

Objectives: Using a microscope to achieve a view of the canal during dewaxing is the most commonly performed method of dewaxing in secondary care, but an endoscope can also be used. We set out to compare endoscopic and microscopic dewaxing.

Design: Randomised clinical trial.

Setting: Otolaryngology Outpatient Department.

Participants: One hundred participants selected sequentially from patients requiring dewaxing of their ears to allow examination of the tympanic membrane. Patients with external or middle ear pathology were excluded.

Methods: Patients were randomly assigned to have dewaxing performed using microinstruments aided by vision with a microscope or an endoscope. All participants who were entered the study completed the study.

Main outcome measures: Levels of pain and discomfort experienced by the participants were assessed by a visual analogue scale (VAS). Difficulty of performing the dewaxing indicated by the endoscopist using a VAS. The length of time taken to perform the dewaxing was also recorded.

Results: Endoscopic dewaxing was less uncomfortable than microscopic dewaxing for patients (VAS median values 5 and 25 respectively; P < 0.002) as well as less painful (VAS median values 3.5 and 10 respectively; P < 0.075). Endoscopic dewaxing was easier to perform than microscopic dewaxing (VAS median values for difficulty were 9 and 20 respectively; P < 0.005) and took less time (mean time for endoscopic dewaxing was 1.8 min versus 3.3 min for microscopic dewaxing (P < 0.001). Ninety-one per cent of ears could be dewaxed with a Jobson-Horne probe or wax hook.

Conclusions: The cost of an operating microscope suitable for use with dewaxing is approximately 10 times that of a suitable endoscope, dewaxing is a cheaper alternative to microscopic dewaxing that has benefits for the patient and clinician.