Because this was a negative results study, there are limitations to answering the framed question of which agent is better at removing wax. First, the fact that the patients receiving saline had the best clearance rate suggests that it should not have been the control but perhaps could be considered another active intervention. The authors concede that fact. Perhaps an irrigation-alone arm of the study would have helped clarify the findings. Second, the study is powered to detect large outcome differences and therefore is susceptible to a type II error, meaning that there is a difference in outcomes but there are too few patients to detect it. Third, another point important to clinicians who may use these medications is that use of only a single dose of the agents is evaluated in the study. This study cannot show whether either agent may be useful when used for a longer time, but this was not what the authors attempted to evaluate. Future studies in which this clinical research question is evaluated should include more patients and consider that saline irrigation alone might actually be the superior approach and not the control method, and they might also seek to answer whether these medications are useful when used for longer periods.