{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T02:12:47Z","timestamp":1767665567299,"version":"3.40.5"},"reference-count":43,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,1,9]],"date-time":"2021-01-09T00:00:00Z","timestamp":1610150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Many different substances for cerumenolysis have been evaluated in clinical trials. We carried out a systematic review and network meta\u2010analysis to compare their effectiveness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Electronic databases were searched for randomised clinical trials conducted in patients with impacted cerumen evaluating cerumenolytics. The primary outcome was the proportion of patients with wax clearance using manual techniques. Rankogram plot was used to assess the \u201cbest\u201d cerumenolytic. Odds ratio (OR) with 95% confidence intervals (95% CI) was the effect estimate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010six studies were included in the systematic review and 25 in the meta\u2010analysis. Sodium bicarbonate (OR: 2.68, 95% CI: 1.2, 6.1) and paradichlorobenzene (OR: 30.9, 95% CI: 5.9, 161.3) were associated with significantly greater proportions of patients with wax clearance following syringing compared to normal saline. Rankogram plot revealed paradichlorobenzene to have the highest probability of being the \u201cbest\u201d cerumenolytic. Chlorobutanol was observed to be significantly better than normal saline in adults as well as following single application. Following multiple applications, glycerol, docusate sodium, hydrogen peroxide, oil, paradichlorobenzene, hydrogen peroxide\/glycerol and arachis oil\/chlorobutanol\/paradichlorobenzene were observed with significant cerumenolytic activities. Urea\/hydrogen peroxide\/glycerol was observed with a significant cerumenolytic activity without the need for further interventions such as syringing\/aspiration\/suction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We observed several cerumenolytics to be effective in the treatment of impacted earwax when accompanied by additional manual techniques such as syringing\/aspiration\/suction.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.13692","type":"journal-article","created":{"date-parts":[[2020,12,17]],"date-time":"2020-12-17T19:59:47Z","timestamp":1608235187000},"page":"464-473","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Cerumenolytics with or without manual extraction for impacted earwax: A network meta\u2010analysis of randomised clinical trials"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3811-6503","authenticated-orcid":false,"given":"Kannan","family":"Sridharan","sequence":"first","affiliation":[{"name":"Department of Pharmacology &amp; Therapeutics College of Medicine &amp; Medical Sciences Arabian Gulf University Manama Kingdom of Bahrain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gowri","family":"Sivaramakrishnan","sequence":"additional","affiliation":[{"name":"Dental Training Department Ministry of Health Manama Kingdom of Bahrain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,1,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.4103\/0300-1652.171620"},{"issue":"5","key":"e_1_2_11_3_1","first-page":"568","article-title":"Incidence of excessive\/impacted cerumen in individuals with mental retardation: a longitudinal investigation","volume":"97","author":"Crandell CC","year":"1993","journal-title":"Am J Ment Retard"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hch082"},{"issue":"8","key":"e_1_2_11_5_1","first-page":"525","article-title":"Cerumen impaction: diagnosis and management","volume":"98","author":"Michaudet C","year":"2018","journal-title":"Am Fam Physician"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2019.102340"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2015.3129"},{"volume-title":"Cerumen Impaction","year":"2020","author":"Sevy JO","key":"e_1_2_11_8_1"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12901-017-0038-8"},{"issue":"7","key":"e_1_2_11_10_1","first-page":"CD012171","article-title":"Ear drops for the removal of ear wax","volume":"7","author":"Aaron K","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-016-1583-7"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/2150132720904181"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"e_1_2_11_14_1","unstructured":"HigginsJPT GreenS editors.Cochrane handbook for systematic reviews of interventions. 5.1.0 edition. 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