Eficácia dos cerumenolíticos - Uma revisão baseada na evidência para Cuidados Primários

Abstract

Goals: Impacted cerumen may have important effects on the well-being of the patient and is a common cause of visits to primary health care. The aim of this article is to review the evidence for the efficacy of cerumenolytic agents for the removal of cerumen. Data sources: Medline, Cochrane Library, National Guideline Clearinghouse, NHS Evidence and DARE. Review methods: A search for randomized controlled trials (RCT), meta-analyses, systematic reviews (SR) and clinical guidelines, published between January, 2000 and August, 2011 in Portuguese and English, using the MeSH terms cerumen and cerumenolytic agents was performed. The Strength of Recommendation Taxonomy (SORT) of the American Family Physician was used to evaluate the quality and the strength of the recommendation of the studies. Results: Of 132 articles found, ten met the inclusion criteria (3 SR, 4 RCT and 3 guidelines). Most articles concluded that cerumenolytic agents were effective in removing impacted cerumen when compared to no treatment, but the data were inconclusive to demonstrate which agent is the most effective. There were no significant differences between cerumenolytic agents, even when compared with a saline solution. Conclusions: Cerumenolytic agents are effective in removing cerumen when compared to no treatment (SOR B). Although there was insufficient evidence to recommend the use of a particular cerumenolytic agent (SOR B), the removal of cerumen can improve the well-being of the patient. Family Physicians should treat impacted cerumen when it is associated with symptoms. If proper instruments or technique for manual removal of cerumen or irrigation are lacking, and considering the associated risk of perforation of the tympanic membrane with these methods, the use of cerumenolytic agents should be considered the most viable option. More methodologically robust patient-oriented studies to assess which agents and which regimens are more effective for the removal of cerumen are needed.