From the Guidelines
The recommended treatment for excessive ear wax is to first try home remedies such as over-the-counter ear drops like Debrox, Murine, or generic carbamide peroxide solutions, as this approach is supported by recent clinical guidelines 1. When considering treatment options, it's essential to prioritize methods that minimize the risk of pushing wax deeper into the ear canal or causing damage to the ear canal or eardrum.
- Home remedies are the initial recommended approach, with options including:
- Over-the-counter ear drops like Debrox, Murine, or generic carbamide peroxide solutions
- Mineral oil, baby oil, or glycerin drops to soften the wax before irrigation
- For irrigation, use body-temperature water (98.6°F/37°C) to avoid dizziness, and never insert cotton swabs, hairpins, or other objects into the ear canal. If home treatments fail, professional removal by a healthcare provider is recommended, especially for those with ear tubes, eardrum perforations, diabetes, or immune system problems, as manual removal can be quicker and allows direct visualization of the external auditory canal 1. Medical professionals can remove wax through:
- Irrigation
- Suction
- Manual removal with specialized instruments It's also important to note that ear wax is beneficial as it protects the ear canal by trapping dust and debris while having antimicrobial properties, but excessive buildup can cause hearing difficulties, ear pain, or tinnitus.
- Regular checking of the ear canal for cerumen by a clinician in hearing aid users can help prevent excessive buildup 1.
- Patients may reduce symptoms from cerumen impaction and need for intervention by performing self-irrigations with bulb syringes at home, as supported by a randomized trial with 237 symptomatic patients with 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 Uses for occasional use as an aid to soften, loosen, and remove excessive earwax
The recommended treatment for excessive ear wax is to use hydrogen peroxide (OTIC) drops, with the following instructions:
- Use 5 to 10 drops in the ear, twice daily for up to 4 days if needed.
- Keep the drops in the ear for several minutes.
- Any remaining wax after treatment may be removed by gently flushing the ear with warm water using a soft rubber bulb ear syringe. 2 2
From the Research
Recommended Treatment for Excessive Ear Wax
The recommended treatment for excessive ear wax involves several methods, including:
- Ear irrigation (syringing) 3
- Manual removal (other than ear irrigation) 3
- Wax softeners prior to irrigation 3
- Wax softeners alone 3
Effectiveness of Ear Drops
Ear drops can be used to remove or aid in the removal of ear wax in adults and children 4. The effectiveness of ear drops depends on the type of drop used, with some studies showing that active treatment is more effective than no treatment 4. However, there is no evidence to show that one type of active treatment is more effective than another 4.
Safety of Ear Wax Removal Methods
The safety of ear wax removal methods is a concern, with some methods carrying a risk of complications such as ear infections, eardrum perforation, and pushing ear wax deeper into the ear 5. Ear syringing is a common practice, but it can also cause complications if not performed properly 6.
Economic Evaluation of Ear Wax Removal Methods
An economic evaluation of ear wax removal methods found that softeners followed by self-irrigation were more likely to be cost-effective than softeners followed by irrigation at primary care 7. However, the evidence base is limited, and further research is required to improve the evidence base and assess the different ways of providing the service 7.
Key Findings
- Ear wax only becomes a problem if it causes a hearing impairment or other ear-related symptoms 3
- Ear wax is more likely to accumulate and cause a hearing impairment when normal extrusion is prevented 3
- The use of cotton buds to clean the ears can cause complications such as ear infections, eardrum perforation, and pushing ear wax deeper into the ear 5
- Softening ear drops may be necessary to help the ear fulfil its self-cleaning function and should be considered first-line treatment 6