You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Effectiveness of ear syringing in general practice: a randomised controlled trial and patients' experiences.
Abstract 1:
BACKGROUND Ear syringing is a common procedure performed for a variety of symptoms in primary care . Reports of its effectiveness vary considerably and no r and omised 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 R and omised single-blind controlled trial . Before- and -after self- assessment s of symptoms . SETTING Patients from three general practice s in the Bristol area attending twice-weekly clinics dedicated to ear syringing over a 12-week period . METHOD Patients were r and omly 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 sef- 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 thresholds , as measure using PTA , and self-reports of hearing improvement . Secondary analysis was unable to identify predictors of objective ly 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


Title 2:
A comparison of the efficacy of two ear drop preparations ('Audax' and 'Earex') in the softening and removal of impacted ear wax.
Abstract 2:
Thirty-six patients with symptoms of impacted ear wax were recruited to an open , r and omized , parallel group study of ' Audax ' ear drops and ' Earex ' ear drops .  Patients had had their symptoms for several weeks and they were assessed on entry for the degree of impaction in each ear . After using the drops , morning and evening for 4 days , they were assessed on the fifth day for degree of impaction , ease of syringing , side-effects or discomfort , and the investigator 's and patient 's own global impression of efficacy of the ear drops . A trend was seen showing less impaction post-treatment in the ' Audax ' group than in the ' Earex ' group although the difference did not reach statistical significance . A significant difference was seen in favour of ' Audax ' for the frequency and ease of syringing ( p < 0.005 ) . No patients in the ' Audax ' group reported any side-effect or discomfort although 1 patient using ' Earex ' reported slight irritation whilst another found the smell unacceptable . The results of the investigators ' and patients ' own global impression of efficacy were significantly in favour of ' Audax ' ear drops ( p < 0.01 )


Title 3:
Randomized clinical trial of docusate, triethanolamine polypeptide, and irrigation in cerumen removal in children.
Abstract 3:
BACKGROUND Cerumen obstructing visualization of the tympanic membrane in children is a common and frustrating problem . Docusate sodium , triethanolamine polypeptide , and saline were compared to determine their effectiveness in relieving cerumen obstruction in children . METHODS A r and omized , controlled , double-blind trial was performed on pediatric patients aged 6 months through 5 years with cerumen obstruction . The enrolling physician determined whether the cerumen completely or partially obstructed visualization of the tympanic membrane . One milliliter of docusate sodium , triethanolamine polypeptide , or normal saline as control was placed into the patient 's ear canal . If the tympanic membrane was not completely visualized after 15 minutes , the ear was irrigated with 50 mL of tepid water . Irrigation was repeated a second time if needed . The main outcome was the proportion of tympanic membranes that were completely visualized after cerumeno-eblytic agents or control saline , alone or with irrigation if needed . RESULTS Of 92 patients enrolled , 34 received docusate sodium ; 30 , triethanolamine polypeptide ; and 28 , saline .  Mean + /- SD patient age was 34.7 + /- 18.1 months , and 50 ( 54 % ) of the patients were girls . Groups were similar in age , race , sex , ear enrolled , wax consistency , and degree of obstruction . There was no significant difference in the proportion of tympanic membranes completely visualized after treatment with docusate ( 18/34 ; 53 % ) , triethanolamine polypeptide ( 13/30 ; 43 % ) , or saline ( 19/28 ; 68 % ) ( P = .17 ) . CONCLUSION Application of docusate sodium or triethanolamine polypeptide did not significantly improve the proportion of tympanic membranes that were completely visualized vs application of the saline control


Title 4:
Ceruminolytic effects of docusate sodium: a randomized, controlled trial.
Abstract 4:
STUDY OBJECTIVE Assessment of the tympanic membrane is often impeded by the presence of cerumen . We compared the ceruminolytic effects of triethanolamine polypeptide and docusate sodium in patients with cerumen . METHODS We conducted a prospect i ve , r and omized , controlled , double-blind trial on a convenience sample of cooperative adult and pediatric patients presenting to a university-based emergency department who required removal of cerumen to visualize the tympanic membrane . Structured data collection was performed , and the physician determined whether visualization of the tympanic membrane was partially or totally obscured by cerumen ( interobserver agreement , rho=0.79 ) . Patients received intra-aural instillation of 1mL of either docusate sodium or triethanolamine polypeptide in a liquid form . If not completely cleared within 15 minutes , the external ear canal was irrigated with 50 or 100 mL of normal saline solution and additional attempts to visualize the tympanic membrane were made . The main outcome was the proportion of ears in which the tympanic membrane could be totally visualized after ceruminolytic instillation with or without irrigation . This study had 80 % power to detect a 40 % difference between groups in the proportion of totally visualized tympanic membranes ( chi(2 ) test , alpha=.05 ) . RESULTS Of 50 enrolled patients , 23 received triethanolamine polypeptide and 27 received docusate sodium .  Mean patient age was 40 years ( range 1 to 81 years ) ; 35 % were female . Groups were similar in age , sex , and proportion of completely obscured tympanic membranes at presentation ( 78 % ) . The ability to completely visualize the tympanic membrane was significantly greater after treatment with docusate sodium versus triethanolamine polypeptide ( 81 % versus 35 % ; difference in proportions 47 % ; 95 % confidence interval [ CI ] , 22 to 71 ) particularly in children aged 5 or less ( 90 % versus 0 % ; difference in proportions 89 % ; 95 % CI 50 to 100 ) . CONCLUSION Docusate sodium solution is a more effective ceruminolytic than triethanolamine polypeptide , allowing complete or partial visualization of the tympanic membrane in most patients after a single application when followed with irrigation . Use of docusate sodium as a ceruminolytic should be encouraged , particularly in children


Title 5:
A single-blind, randomized study to compare the efficacy of two ear drop preparations ('Audax' and 'Cerumol') in the softening of ear wax.
Abstract 5:
A parallel group , single-blind , r and omized study was carried out in a general practice to compare the effectiveness and tolerability of two ear drop preparations ( ' Audax ' and ' Cerumol ' ) in the softening of ear wax in 50 adult patients with impacted or hardened ear wax . Assessment s were made on entry of the amount , colour and consistency of the ear wax , symptoms , and objective hearing . Patients were then allocated at r and om to receive one or other preparation and instructed to use the drops , morning and evening , for 4 days after which they were reassessed . Details were recorded of any side-effects or discomfort caused by the study medication and both physician and patients were asked to give their overall opinion of treatment efficacy . Both treatments were shown to be effective in the softening of ear wax and were well tolerated , there being no significant difference between the two groups in these parameters . However , patients who had abnormal hearing before treatment had a significantly greater improvement in objective hearing after treatment with ' Audax ' ear drops compared to those patients treated with ' Cerumol ' ear drops . There were no between-treatment differences in either either the physician 's or patient 's overall assessment s of effectiveness


Title 6:
An evaluation of a nurse-led ear care service in primary care: benefits and costs.
Abstract 6:
BACKGROUND  Nurses trained in ear care  provide a new model for the provision of services in general practice , with the aim of cost-effective treatment of minor ear and hearing problems that affect well-being and quality of life .  AIM To compare a prospect i ve observational cohort study measuring health outcomes and re source use for patients with ear or hearing problems treated by nurses trained in ear care with similar patients treated by st and ard practice . METHOD A total of 438 Rotherham and 196 Barnsley patients aged 16 years or over received two self-completion question  naires : question naire 1 ( Q1 ) on the day of consultation and question naire 2 ( Q2 ) after three weeks . Primary measured outcomes were changes in discomfort and pain ; secondary outcomes included the effect on normal life , health status , patient satisfaction , and re sources used . RESULTS After adjusting for differences at Q1 , by Q2 there was no statistical evidence of a difference in discomfort and pain reduction , or differential change in health status between areas . Satisfaction with treatment was significantly higher ( P = 0.0001 ) in Rotherham ( 91 % ) than in Barnsley ( 82 % ) . Average total general practitioner ( GP ) consultations were lower in Rotherham at 0.4 per patient with an average cost of 6.28 Pounds compared with Barnsley at 1.4 per patient and an average cost of 22.53 Pounds ( P = 0.04 ) . Barnsley GPs prescribed more drugs per case ( 6 % of total costs compared with 1.5 % ) and used more systemic antibiotics ( P = 0.001 ) . CONCLUSIONS Nurses trained in ear care reduce costs , GP workload , and the use of systemic antibiotics , while increasing patient satisfaction with care . With underst and ing and support from GPs , such nurses are an example of how exp and ed nursing roles bring benefits to general practice . Nurses trained in ear care reduce treatment costs , reduce the use of antibiotics , educate patients in ear care , increase patient satisfaction , and raise ear awareness


Title 7:
Ceruminolytic efficacy in adults versus children.
Abstract 7:
OBJECTIVES An inexpensive , nontoxic ceruminolytic with reasonable efficacy that can be used by the patient or their caregivers at home could represent significant financial saving for patients and health care systems . The purpose of this study was to compare two simple ceruminolytics for in vitro efficacy . STUDY DESIGN R and omized controlled trial . METHODS Thirty-six children and 33 adults presenting to a community family practice clinic who had cerumen occluding at least one external auditory canal were r and omly assigned to compare use of 10 % aqueous sodium bicarbonate and 2.5 % aqueous acetic acid as ceruminolytics in occlusive cerumen . RESULTS We were unable to demonstrate a difference between in vivo efficacy of these two ceruminolytic solutions , but both solutions were significantly more efficacious in children than adults . CONCLUSIONS There is a role for these ceruminolytics in children with occlusive cerumen , but adults would be better treated in another way


Title 8:
A Multicentric Clinical Trial Comparing Otocerol® with Cerumol® as Cerumenolytics
Abstract 8:
Fifteen general practitioners conducted a r and omized , double-blind comparative trial of two cerumenolytics , namely , Otocerol ® and Cerumol ® .  A total of 106 patients were entered into the study ( fifty-three in each group ) . Otocerol was shown to be marginally better than Cerumol in all parameters evaluated
A non-water- , non-oil-based preparation appeared more effective than an oil-based preparation at both clearing earwax without syringing , and facilitating successful syringing .
Immediate syringing after application of a preparation may be as effective as using eardrops for several days and delaying syringing .
Although immediate ear syringing is effective and convenient for patients , it may be less cost-effective than using eardrops and perhaps avoiding syringing .