From the Guidelines
The recommended approach for managing impacted cerumen (earwax) is to first attempt at-home treatments with over-the-counter cerumenolytic agents, followed by gentle irrigation with warm water, and if necessary, professional removal by a healthcare provider. This approach is based on the most recent and highest quality study available, which emphasizes the importance of safe and effective methods for managing impacted cerumen 1. The use of cerumenolytic agents, such as hydrogen peroxide solutions, mineral oil, or commercial ear drops like Debrox or Murine, can help soften the wax, making it easier to remove 1. Gentle irrigation with warm water using a bulb syringe can then be used to flush out the softened wax. If self-care measures fail, professional removal by a healthcare provider is recommended, which may involve manual removal with specialized instruments, irrigation with a water jet device, or suction 1. It is also important to note that ear candling should be avoided as it's ineffective and potentially dangerous 1. Prevention of future impactions includes avoiding cotton swabs for ear cleaning and using preventive drops (such as mineral oil or over-the-counter preparations) once or twice monthly if you're prone to wax buildup.
Some key points to consider when managing impacted cerumen include:
- The importance of avoiding cotton swabs for ear cleaning, as they can push the wax further into the ear canal and potentially cause damage 1
- The use of cerumenolytic agents, which can help soften the wax and make it easier to remove 1
- The importance of gentle irrigation with warm water, which can help flush out the softened wax 1
- The potential need for professional removal by a healthcare provider, which may involve manual removal with specialized instruments, irrigation with a water jet device, or suction 1
- The importance of preventing future impactions by avoiding cotton swabs and using preventive drops regularly 1
Overall, the key to managing impacted cerumen is to use a safe and effective approach that minimizes the risk of complications and promotes the best possible outcomes for patients. By following the recommended approach and taking steps to prevent future impactions, patients can help protect their ear health and prevent symptoms like hearing loss, fullness, itching, or pain.
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 The recommended approach for managing impacted cerumen (earwax) is to:
- Use hydrogen peroxide (OTIC) drops in the ear, with 5 to 10 drops administered twice daily for up to 4 days if needed
- Keep the drops in the ear for several minutes
- Remove any remaining wax by gently flushing the ear with warm water using a soft rubber bulb ear syringe 2
From the Research
Impacted Cerumen Management
Impacted cerumen, or earwax, can cause symptoms such as hearing loss, itching, pain, and tinnitus, and can prevent assessment of the external auditory canal, the tympanic membrane, or audiovestibular system 3, 4.
Recommended Approach
The recommended approach for managing impacted cerumen includes:
- Cerumenolytic agents
- Irrigation with or without cerumenolytic pretreatment
- Manual removal
- Home irrigation with a bulb syringe for selected adults 3, 5
- Avoiding the use of cotton-tipped swabs, ear candling, and olive oil drops or sprays 3, 4
Special Considerations
Patients with coagulopathies, hepatic failure, thrombocytopenia, or hemophilia, and those taking antiplatelet or anticoagulant medications, should be counseled about the increased risk of bleeding in the external auditory canal when cerumen is removed 3. Referral to an otolaryngologist is indicated if treatment is ineffective, or if the patient develops severe pain or has vertigo during irrigation, or if hearing loss is still present after cerumen has been removed 4, 6.
Treatment Options
Treatment options for cerumen impaction include: