What medications are recommended for an 18-year-old with cerumen (earwax) impaction in the right ear?

From the Guidelines

For cerumen impaction in an 18-year-old, over-the-counter ear drops containing carbamide peroxide (such as Debrox or Murine) or mineral oil, olive oil, or hydrogen peroxide solutions are recommended as first-line treatments. These should be used as directed on the package, typically 5-10 drops in the affected right ear twice daily for 3-4 days 1. After application, the patient should remain with the treated ear facing upward for 5-10 minutes to allow the solution to penetrate the wax. Following the softening period, gentle irrigation with warm water using a bulb syringe can help remove the loosened wax. These medications work by either dissolving the wax or softening it to facilitate removal. Some key points to consider when treating cerumen impaction include:

• The use of cerumenolytic agents, such as carbamide peroxide or hydrogen peroxide, to soften the wax 1
• The use of irrigation, such as with a bulb syringe, to remove the loosened wax 1
• The importance of avoiding the use of cotton swabs or other objects to remove earwax, as this can push the wax deeper or damage the ear canal 1 If home treatment is unsuccessful after 3-4 days, or if the patient experiences pain, hearing loss, dizziness, or drainage, they should seek medical attention for professional removal. Patients should also be educated on the proper use of ear drops and irrigation, as well as the importance of avoiding certain practices, such as using ear candles or inserting objects into the ear canal 1.

From the FDA Drug Label

adults and children over 12 years of age: • tilt head sideways • 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 four days if needed, or as directed by a doctor • any wax remaining after treatment may be removed by gently flushing the ear with warm water, using a soft rubber bulb ear syringe

For an 18-year-old with cerumen impaction in the right ear, carbamide peroxide (OTIC) is recommended. The medication should be used as directed:

• Tilt head sideways and place 5 to 10 drops into the affected ear.
• Keep the drops in the ear for several minutes.
• Use twice daily for up to four days if needed, or as directed by a doctor.
• Any remaining wax can be removed by gently flushing the ear with warm water using a soft rubber bulb ear syringe 2.

From the Research

Medications for Cerumen Impaction

The following medications are recommended for an 18-year-old with cerumen impaction in the right ear:

• Cerumenolytic agents, such as carbamide peroxide, which can help dissolve the earwax 3
• Irrigation with or without cerumenolytic pretreatment, which can help remove the earwax 4, 5
• Manual removal, which may be necessary if other treatments are ineffective or contraindicated 4, 5

Treatment Options

Treatment options for cerumen impaction include:

• Home irrigation with a bulb syringe, which may be appropriate for selected adults 5
• Cerumenolytic agents, such as carbamide peroxide, which can be used to dissolve the earwax 3
• Irrigation with or without cerumenolytic pretreatment, which can help remove the earwax 4, 5

Contraindications and Precautions

Certain medications and conditions may be contraindicated or require precautions when treating cerumen impaction, including:

• Antiplatelet or anticoagulant medications, which may increase the risk of bleeding in the external auditory canal 5
• Coagulopathies, hepatic failure, thrombocytopenia, or hemophilia, which may also increase the risk of bleeding 5