From the Guidelines
Cerumen impaction should be treated with manual removal by a healthcare provider, as it is often quicker and allows for direct visualization of the external auditory canal, according to the most recent clinical practice guideline update in 2017 1. To address cerumen impaction, the following steps can be taken:
- Start with home remedies using over-the-counter ear drops like Debrox or Murine (containing carbamide peroxide or hydrogen peroxide) twice daily for 3-4 days.
- After applying drops, wait 5-10 minutes, then gently irrigate with warm water using a soft rubber bulb syringe.
- Alternatively, mineral oil, baby oil, or glycerin can be used to soften the wax before irrigation.
- If home treatment fails or if you have ear tubes, a perforated eardrum, diabetes, or a weakened immune system, seek professional care. Some key points to consider:
- Healthcare providers can remove impacted cerumen through manual removal with specialized tools, irrigation with warm water, or suction.
- Prevention involves avoiding cotton swabs which can push wax deeper, using preventive ear drops monthly if you're prone to impactions, and getting regular ear check-ups.
- Cerumen naturally protects the ear by trapping dust and debris while having antimicrobial properties, but excessive production or improper cleaning can lead to impaction.
- The use of cerumenolytic agents during the week prior to the office visit can reduce potential side effects of suction removal, such as pain or vertigo 1.
- Manual removal of cerumen is often preferred in patients with abnormal otologic findings (eg, obstructing exostoses) 1. It is essential to note that cerumen impaction can cause symptoms such as hearing loss, ear fullness, itching, or pain, and if left untreated, can lead to more severe complications, as highlighted in the clinical practice guideline update in 2017 1.
From the FDA Drug Label
Uses for occasional use as an aid to soften, loosen, and remove excessive earwax The hydrogen peroxide (OTIC) can be used for cerumen impaction as it is indicated for occasional use to soften, loosen, and remove excessive earwax 2.
- Key points:
- Aid to soften, loosen, and remove excessive earwax
- For occasional use
- Warning: For use in the ear only, and stop use if excessive earwax remains after use of this product 2
From the Research
Cerumen Impaction Symptoms and Indications for Removal
- Cerumen production is a normal process, but removal is necessary when it causes symptoms such as:
- Hearing loss
- Itching
- Pain
- Tinnitus
- Removal is also indicated when cerumen prevents assessment of the external auditory canal, the tympanic membrane, or audiovestibular system 3
- Additionally, cerumen should be removed in patients who cannot communicate their symptoms, such as those with dementia, developmental delay, or young children with fever, speech delay, or parental concerns 3
Special Considerations for Cerumen Removal
- Patients with certain medical conditions, such as coagulopathies, hepatic failure, thrombocytopenia, or hemophilia, should be counseled about the increased risk of bleeding in the external auditory canal when cerumen is removed 3
- Those taking antiplatelet or anticoagulant medications should also be informed of this risk 3
Treatment Options for Cerumen Impaction
- Effective treatment options include:
- Cerumenolytic agents
- Irrigation with or without cerumenolytic pretreatment
- Manual removal
- Home irrigation with a bulb syringe may be suitable for selected adults 3
- Methods to avoid include:
- Cotton-tipped swabs
- Ear candling
- Olive oil drops or sprays 3