What is the best approach to self-manage cerumen (earwax) impaction?

From the Guidelines

The best approach to self-manage cerumen (earwax) impaction is to use over-the-counter ear drops specifically designed for earwax removal, followed by gentle irrigation, as recommended by the most recent clinical practice guideline update in 2017 1.

Key Considerations

• Start with drops containing carbamide peroxide (such as Debrox or Murine Ear Wax Removal System) or mineral oil, placing 5-10 drops in the affected ear twice daily for 3-4 days.
• After applying drops, remain with your head tilted for 5 minutes to allow the solution to penetrate and soften the wax.
• Once the wax has softened, gently flush the ear with warm (body temperature) water using a soft rubber bulb syringe.
• Never insert cotton swabs, hairpins, or other objects into your ear canal as these can push wax deeper or damage the ear canal or eardrum, as cautioned by multiple studies including those from 2008 and 2017 1.

Important Precautions

• If you experience ear pain, drainage, hearing loss that doesn't improve after treatment, dizziness, or have a history of ear surgery or eardrum perforation, seek medical attention instead of attempting self-management.
• Earwax is beneficial as it protects and lubricates the ear canal while trapping dust and other particles, but excessive production or impaired natural clearing mechanisms can lead to blockages that require intervention, as noted in the clinical practice guideline update 1.

Additional Recommendations

• Regular cleaning of the ears performed every 6 to 12 months by professionals or routine self-care measures such as irrigating the ears or using topical preparations might prevent cerumen from accumulating in the ear canal and causing an impaction, as suggested by studies including one from 2017 1.
• Patients with an increased propensity for cerumen production might benefit from regular ear care to reduce the risk of developing an impaction, as indicated by research findings 1.

From the FDA Drug Label

Directions FOR USE IN THE EAR ONLY. Adults and children over 12 years of age: Tilt head sideways and place 5 to 10 drops into ear Tip of applicator should not enter ear canal Keep drops in ear for several minutes by keeping head tilted or placing cotton in the ear Use twice daily for up to 4 days if needed, or as directed by a doctor Any wax remaining after treatment may be removed by gently flusing the ear with warm water, using a soft rubber bulb ear syringe Uses for occasional use as an aid to soften, loosen, and remove excessive earwax

The best approach to self-manage cerumen impaction is to use hydrogen peroxide (OTIC) drops, following the instructions:

• Tilt head sideways and place 5 to 10 drops into the ear
• Keep drops in the ear for several minutes
• Use twice daily for up to 4 days if needed
• Remove any remaining wax by gently flushing the ear with warm water, using a soft rubber bulb ear syringe 2. This method is intended for occasional use to soften, loosen, and remove excessive earwax 2.

From the Research

Self-Management of Cerumen Impaction

To self-manage cerumen impaction, several approaches can be considered:

• Using ear drops to remove or aid in the removal of ear wax, with options including oil-based compounds, water-based compounds, or non-water, non-oil-based solutions 3
• Irrigation with or without cerumenolytic pretreatment, which can be effective in removing impacted cerumen 4, 5
• Manual removal, although this may require specialized training and equipment to prevent adverse outcomes 5

Effective Treatment Options

Effective treatment options for cerumen impaction include:

• Cerumenolytic agents, which can help soften and remove ear wax 3, 4
• Irrigation with a bulb syringe, which may be appropriate for selected adults 4
• Avoiding the use of cotton-tipped swabs, ear candling, and olive oil drops or sprays, as these can push the wax further into the ear canal or cause other complications 4

Considerations for Self-Management

When self-managing cerumen impaction, it is essential to consider the following:

• The use of ear drops or irrigation should be done carefully to avoid pushing the wax further into the ear canal or causing damage to the ear 3, 4
• If multiple attempts to remove the impacted cerumen are ineffective, it may be necessary to consult a healthcare professional or otolaryngologist for further evaluation and treatment 4, 5
• Persistent symptoms despite resolution of the impaction should prompt further evaluation for an alternative diagnosis 4