Brand Names of Acidic Ear Drops
For earwax removal, acetic acid-based drops are available without a specific brand name as generic "acetic acid otic solution," while for ear infections, VoSol is a branded acidic preparation containing 2% acetic acid. 1, 2
Acidic Ear Drops for Earwax (Cerumen) Management
Water-Based Acidic Preparations
- Acetic acid is listed as a water-based cerumenolytic agent containing aqueous acetic acid, though it is typically available as a generic formulation rather than under a specific brand name 1
- The American Academy of Otolaryngology-Head and Neck Surgery recognizes acetic acid as an acceptable cerumenolytic option for managing cerumen impaction 1
Non-Water, Non-Oil Based Preparations
- Audax contains choline salicylate and glycerine, which has acidic properties and has been studied for earwax softening 1, 3
- Debrox contains carbamide peroxide (urea-hydrogen peroxide), which releases acidic compounds 1
Acidic Ear Drops for Ear Infections
Acetic Acid-Based Antiseptic Drops
- VoSol is a branded otic solution containing 2% acetic acid and 3% propylene glycol, used for treating acute otitis externa 2, 4
- Generic acetic acid otic solutions (typically 2% concentration) are widely available for treating external ear infections 2
Important Clinical Considerations
Mechanism and Efficacy
- Acetic acid works by creating an acidic environment that inhibits bacterial growth, particularly Pseudomonas aeruginosa and Staphylococcus aureus, the most common pathogens in acute otitis externa 1
- For cerumen management, water-based acidic agents induce hydration and fragmentation of corneocytes within the earwax 1
Administration Protocol for Acetic Acid
- The FDA-approved dosing for acetic acid otic solution requires saturating a cotton wick and keeping it moist with 3-5 drops every 4-6 hours for at least 24 hours, followed by 5 drops 3-4 times daily thereafter 2
- In pediatric patients, 3-4 drops may be sufficient due to smaller ear canal capacity 2
Critical Safety Warning: Ototoxicity Risk
- VoSol (acetic acid 2% with propylene glycol) has demonstrated significant ototoxicity in animal studies, causing severe depression of endocochlear potential and inner ear pH changes 4, 5
- The ototoxicity of VoSol was found to be four times greater than Cortisporin in animal models measuring hearing loss at 24 hours 5
- Acetic acid preparations should NEVER be used if tympanic membrane perforation is suspected or confirmed, as the acidic solution can damage inner ear structures 4
Comparative Effectiveness
For Earwax Removal:
- Evidence comparing acetic acid to other cerumenolytics shows no clear superiority of one agent over another 6
- Low-quality evidence suggests acetic acid may actually be less effective than aminoglycoside antibiotics for resolving ear discharge at 1-2 weeks 7
For Ear Infections:
- Topical quinolone antibiotics are significantly more effective than acetic acid (boric acid comparison) for resolving ear discharge, with one additional person achieving resolution for every four treated (moderate-certainty evidence) 7
- Acetic acid may increase resolution compared to aminoglycosides but the evidence is of low certainty 7
Common Pitfalls to Avoid
- Do not use acidic ear drops if there is any possibility of tympanic membrane perforation - this can cause severe inner ear damage 4
- Ensure the ear canal is cleared of debris before application, as obstructing cerumen prevents adequate drug delivery 1
- Patients must remain lying down with the affected ear upward for 3-5 minutes after instillation to allow proper penetration 1, 8
Alternative Considerations
- For prevention of swimmer's ear, acidifying drops (including acetic acid) can be used shortly before swimming, after swimming, or at bedtime 1
- If treating acute otitis externa with uncertain tympanic membrane status, fluoroquinolone drops (ciprofloxacin or ofloxacin) are safer choices as they are non-ototoxic even with perforation 8