From the Guidelines
Cerumen impaction in children should be treated with gentle irrigation or manual removal by a healthcare provider, prioritizing the method that ensures the safest and most effective removal of the impaction while minimizing the risk of complications 1.
Treatment Options
- For home management, over-the-counter ear drops like Debrox (carbamide peroxide 6.5%) or Cerumenex (triethanolamine polypeptide) can be used twice daily for 3-4 days to soften the wax before removal.
- Alternatively, mineral oil, baby oil, or olive oil (2-3 drops twice daily for 3-4 days) can soften the wax.
- Never use cotton swabs, which can push wax deeper or damage the ear canal.
Irrigation Method
- For irrigation, use body-temperature water with a soft rubber bulb syringe, directing water toward the roof of the canal.
- If the child has ear tubes, perforated eardrum, or ear pain, avoid home irrigation and seek medical care.
Professional Removal
- Professional removal is recommended for severe impaction, as children have narrower ear canals than adults and are more prone to injury during removal.
- Manual removal requires adequate illumination, visualization, instrumentation, and competence in performing the procedure, and can be performed using various instruments such as a handheld speculum or otoscope, a headlamp or head mirror, or the binocular microscope 1.
Importance of Follow-Up
- After treatment, it is essential to assess the patient to confirm the resolution of the impaction and to evaluate for any potential complications or alternative diagnoses if symptoms persist 1.
- Cerumen naturally protects the ear canal by trapping debris and has antimicrobial properties, but excessive production or improper cleaning can lead to impaction that causes hearing difficulties, ear fullness, or discomfort.
From the FDA Drug Label
Directions FOR USE IN THE EAR ONLY. ... Children under 12 years: consult a doctor adults and children over 12 years of age: ... use twice daily for up to four days if needed, or as directed by a doctor
For pediatric patients over 12 years, the treatment for cerumen (earwax) impaction is to use hydrogen peroxide (OTIC) or carbamide peroxide (OTIC) twice daily for up to 4 days if needed, or as directed by a doctor 2 3. For pediatric patients under 12 years, the FDA recommends to consult a doctor 2 3.
From the Research
Treatment Options for Cerumen Impaction in Pediatric Patients
- Cerumen impaction can be treated with cerumenolytics, ear irrigation, and manual removal with instrumentation 4, 5, 6
- The use of cotton swabs and ear candles should be avoided 4, 5
- Ear drops can be used to remove or aid the removal of ear wax in children, with various types of liquids available, including oil-based compounds, water-based compounds, and non-water, non-oil-based solutions 7
Efficacy of Treatment Options
- A study found that an aural irrigation system can be effective at clearing impacted cerumen from pediatric ear canals with minimal discomfort and no trauma 8
- Another study found that applying ear drops for five days may result in a greater likelihood of complete wax clearance than no treatment at all, but there is no evidence to show that one type of active treatment is more effective than another 7
Considerations for Treatment
- Patients with hard, spherical, or cylindrical objects in their ear canal should be referred to an otolaryngologist if previous removal attempts have failed or if there is ear trauma 4
- Clinicians should evaluate for cerumen impaction in patients using hearing aids and patients with intellectual disability 4
- The choice of treatment depends on the type of foreign body and the patient's circumstances 4, 5