From the Guidelines
In Australia, the most effective treatment option for cerumen impoucher (ear wax impoucher) is the use of cerumenolytic agents, such as Waxsol (docusate sodium), Earclean (carbamide peroxide), or Cerumol (arachis oil and chlorobutanol), followed by irrigation with warm water using a bulb syringe, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1.
Treatment Options
The following treatment options are available for cerumen impoucher in Australia:
- At-home treatment with over-the-counter products like Waxsol, Earclean, or Cerumol, which are used to soften and help remove ear wax by placing 3-5 drops in the affected ear twice daily for 3-4 days 1.
- Manual removal using olive oil drops for 2-3 days to soften wax before irrigation, which can be performed by a healthcare professional 1.
- Professional options, including microsuction, irrigation, or manual removal by a healthcare professional, which are available at GP clinics, audiology centers, and some pharmacies across Australia 1.
Important Considerations
It is essential to note that ear wax is actually protective, containing antimicrobial properties that help prevent ear infections, but excessive buildup can cause hearing issues, discomfort, or tinnitus, warranting removal 1.
Recommendations
The use of cotton-tipped swabs to remove cerumen from the ear canal is not recommended, as it can cause complications, including fatal otogenic meningitis and brain abscess due to retained cotton swabs 1. Instead, patients can use cerumenolytic agents, followed by irrigation with warm water using a bulb syringe, to safely and effectively remove ear wax 1.
From the Research
Treatment Options for Cerumen Impaction in Australia
- Ear syringing is a common practice among general practitioners (GPs) in Australia, but it is recommended to use softening ear drops as the first-line treatment to help the ear fulfill its self-cleaning function 2
- Referral to an ENT clinic for manual removal with microsuctioning may be necessary in the event of contraindications, complications, or failure of ear syringing 2
- Watchful waiting, manual removal, the use of ceruminolytic agents, and irrigation with or without ceruminolytic pretreatment are also treatment options for cerumen impaction 3
- The use of cotton swabs and ear candles should be avoided as they can cause further complications 3
Effectiveness of Treatment Options
- A systematic review found that ear irrigation (syringing), manual removal, wax softeners prior to irrigation, and wax softeners alone are effective interventions for removing ear wax, but the quality of evidence is limited 4
- A study comparing the effectiveness of different pre-treatments for ear irrigation found that a docusate-sodium-based preparation may be more effective, but the results were not statistically significant 5
- The same study found that ear irrigation was less successful for patients aged 70 years or older 5
Recommendations for Healthcare Providers
- Healthcare providers should take a thorough history and examination to exclude contraindications and gain patient consent before performing ear syringing 2
- Referral to an otolaryngologist for further evaluation is indicated if treatment with a ceruminolytic agent followed by irrigation is ineffective, or if manual removal is not possible 3