From the Guidelines
The best over-the-counter remedies for outpatient cerumen impaction include oil-based products like mineral oil, baby oil, or olive oil, and water-based products such as hydrogen peroxide solutions, carbamide peroxide (Debrox, Murine), or sodium bicarbonate solutions. For effective home treatment, place 2-3 drops of your chosen solution into the affected ear with the head tilted, remain in this position for 5-10 minutes to allow the solution to soften the wax, then gently flush with warm water using a bulb syringe 1. This regimen can be repeated twice daily for 3-5 days. Oil-based products work by lubricating and softening the wax, while peroxide-based solutions help break down the cerumen through bubbling action.
Important Considerations
- The use of ear candles is not recommended as there is no evidence that they remove impacted cerumen, and candling can cause serious damage to the ear canal and eardrum 1.
- Irrigation or the use of cerumen-removing/softening drops should be avoided if you have had ear surgery or a perforated eardrum, unless specifically cleared to do so by your otolaryngologist (ear, nose, and throat surgeon) 1.
- If symptoms persist after 5 days of home treatment, or if you experience pain, drainage, hearing loss, dizziness, or have a history of ear surgery or perforated eardrum, seek professional medical care as these remedies may not be appropriate for your condition.
Treatment Options
- Water-based products:
- Hydrogen peroxide solutions
- Carbamide peroxide (Debrox, Murine)
- Sodium bicarbonate solutions
- Oil-based products:
- Mineral oil
- Baby oil
- Olive oil
- Nonwater, nonoil based products:
- Audax (choline salicylate, glycerine)
Prevention
- Regular ear care can help prevent recurrence of cerumen impaction, including instilling prophylactic topical preparations, irrigating the ear canal, cleaning hearing aids, or routine cleaning of the ear canal by a clinician 1.
- Patients can purchase wax-softening drops or home irrigation kits as part of an ear hygiene regimen to help prevent recurrence of cerumen occlusions 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 Directions FOR USE IN THE EAR ONLY 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
The best over-the-counter (OTC) remedies for outpatient cerumen impaction are:
- Hydrogen peroxide (OTIC) 2
- Carbamide peroxide (OTIC) 3 Key steps for using these remedies include:
- Tilt head sideways and place 5 to 10 drops into ear
- Keep drops in 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 Important note: Children under 12 years should consult a doctor before using these remedies.
From the Research
Over-the-Counter Remedies for Outpatient Cerumen Impaction
The following are some of the best over-the-counter (OTC) remedies for outpatient cerumen impaction:
- Cerumenolytic agents: These are substances that help dissolve earwax, making it easier to remove 4, 5.
- Irrigation with a bulb syringe: This method involves using a bulb syringe to gently flush out the ear canal with warm water 4, 5.
- Carbamide peroxide ear drops: These drops have been shown to be effective in degrading cerumen and can be used to help remove earwax 6.
Precautions and Contraindications
It's essential to note that some methods should be avoided, such as:
- Using cotton-tipped swabs, as they can push the earwax further into the ear canal and potentially cause damage 5.
- Ear candling, as it is not a recommended or effective method for removing earwax 5.
- Olive oil drops or sprays, as they are not a recommended treatment for cerumen impaction 5.
When to Seek Medical Attention
If multiple attempts to remove the impacted cerumen are ineffective, or if symptoms persist despite treatment, it's recommended to seek medical attention from an otolaryngologist 4, 5. Additionally, patients with certain medical conditions, such as coagulopathies or those taking antiplatelet or anticoagulant medications, should be cautious when attempting to remove earwax and may need to consult a healthcare professional 5.