Treatment of Impacted Earwax (Cerumen)
The most effective approach for treating impacted cerumen is to use a cerumenolytic agent (such as carbamide peroxide/Debrox) for 3-5 days, followed by irrigation if needed, or to seek professional manual removal by a healthcare provider. 1, 2
First-Line Treatment Options
Cerumenolytic Agents
Water-based options:
- Hydrogen peroxide (5-10 drops twice daily for up to 4 days) 3
- Sodium bicarbonate
- Docusate sodium
- Sterile saline solution
Oil-based options:
- Olive oil
- Almond oil
- Mineral oil/liquid petrolatum
Non-water, non-oil based:
- Carbamide peroxide (Debrox) - 5-10 drops 2-3 times daily for up to 5 days 2
Administration Technique
- Warm solution to body temperature
- Tilt head with affected ear upward
- Apply 5-10 drops into ear canal
- Maintain position for 5-10 minutes
- Optional: place cotton ball gently at ear opening to prevent leakage
- Repeat 2-3 times daily for 3-5 days 2
Second-Line Treatment: Irrigation
If cerumenolytics alone are insufficient after 3-5 days:
- Use body temperature water to avoid caloric effects 1
- Can be performed with a syringe or electronic irrigator
- Direct water along canal wall, not directly at eardrum
- Can improve hearing by 5-10 dB in affected ears 1
Third-Line Treatment: Manual Removal
When cerumenolytics and irrigation are ineffective:
- Requires specialized instruments (curettes, forceps, or suction)
- Should be performed by a trained healthcare provider 1
Treatment Effectiveness
- No single cerumenolytic agent has proven superior to others 2, 4
- Using a cerumenolytic prior to irrigation is more effective than irrigation alone 1, 2
- Water-based and oil-based preparations are equally effective 5
- Non-water, non-oil-based preparations (like carbamide peroxide) may be more effective than oil-based preparations 5
Contraindications and Precautions
Do NOT use cerumenolytics or irrigation in patients with:
- Ear pain, drainage, or bleeding
- History of tympanic membrane perforation
- Previous ear surgery or ear tubes
- Children under 3 years of age 2
Avoid these methods:
- Cotton-tipped swabs (can push wax deeper)
- Ear candling/coning (ineffective and potentially dangerous) 1
- Home use of oral jet irrigators 1
Potential Complications
- Pain (most common)
- Injury to ear canal skin
- Acute otitis externa
- Tympanic membrane perforation (0.2%)
- Vertigo (0.2%) 1
Prevention for Recurrent Impaction
- Regular professional ear cleaning every 6-12 months 2
- Monthly application of cerumenolytic drops followed by gentle irrigation 2
- Weekly use of a topical emollient (reduced recurrence rate from 61% to 23% in one study) 6
- Hearing aid users: more frequent ear checks (every 3-6 months) and regular cleaning of hearing aids 2