From the Guidelines
The recommended treatment for impacted cerumen includes cerumenolytic agents, irrigation, or manual removal by a healthcare provider, with the goal of restoring normal hearing and preventing complications like infection or hearing loss. The treatment options for impacted cerumen are varied and depend on the severity of the impaction and the patient's overall health.
- Cerumenolytic agents, such as mineral oil or hydrogen peroxide solutions, can be used to soften the wax, making it easier to remove 1.
- Irrigation with body-temperature water using a bulb syringe or electronic irrigator is another effective method, but it should be done with caution to avoid damaging the ear canal or eardrum 1.
- Manual removal by a healthcare provider using specialized instruments like curettes or suction is recommended for difficult cases or when irrigation is contraindicated 1. It is essential to note that patients should avoid using cotton swabs or other objects to remove earwax, as these can push wax deeper and damage the ear canal or eardrum 1. Preventive measures, such as periodic use of cerumenolytic drops or gentle irrigation, can help reduce the risk of impaction in prone individuals 1. The choice of treatment should be based on the patient's specific needs and medical history, and it is crucial to follow up with a healthcare provider to ensure the impaction is resolved and to address any potential complications. In general, the treatment of impacted cerumen should prioritize the patient's safety and comfort, and it is essential to educate patients on the proper care and maintenance of their ears to prevent future impactions. Overall, the goal of treatment is to restore normal hearing and prevent complications, while also ensuring the patient's safety and comfort.
From the Research
Impacted Cerumen Treatment
The recommended treatment for impacted cerumen includes:
- Watchful waiting
- Manual removal
- The use of ceruminolytic agents
- Irrigation with or without ceruminolytic pretreatment 2, 3 Some key points to consider when treating impacted cerumen:
- Referral to an otolaryngologist is indicated if treatment with a ceruminolytic agent followed by irrigation is ineffective, if manual removal is not possible, if the patient develops severe pain or has vertigo during irrigation, or if hearing loss is still present after cerumen has been removed 2
- 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
- The use of cotton swabs and ear candles should be avoided 2, 3
Cerumenolytic Agents
Cerumenolytic agents are used to soften and remove ear wax, and include:
- Oil-based compounds (e.g. olive or almond oil)
- Water-based compounds (e.g. sodium bicarbonate or water itself)
- A combination of the above or non-water, non-oil-based solutions, such as carbamide peroxide (a hydrogen peroxide-urea compound) and glycerol 4 Some studies have compared the effectiveness of different cerumenolytic agents, but the evidence is limited and inconclusive 4, 5 One study found that carbamide peroxide was effective in degrading cerumen and may be a proper treatment for patients with ear canal obstruction caused by cerumen compaction 6
Irrigation
Irrigation with or without ceruminolytic pretreatment is a common method for removing impacted cerumen 2, 3 Home irrigation with a bulb syringe may be appropriate for selected adults 3 However, irrigation should be done with caution, as it can cause discomfort, irritation, or pain, and may not be effective in all cases 4