What are the recommended ear drops for cerumen (earwax) removal in pediatric patients?

From the Guidelines

For children with ear wax buildup, the most effective treatment is the use of a cerumenolytic agent, such as docusate, triethanolamine polypeptide, or saline, as they have shown no statistical difference between groups after instillation of drops and following one or two attempts of irrigation 1. When using ear drops for wax removal in children, it is essential to consider the age and safety of the child.

• For children aged 6 months to 5 years, docusate, triethanolamine polypeptide, or saline can be used, as they have been shown to be effective in clinical practice guidelines 1.
• The treatment protocol should include instillation of drops, followed by one or two attempts of irrigation if the ears are not completely clear after a 15-minute period.
• It is also important to note that topical therapy is more effective in children than in adults, according to two studies cited in the clinical practice guideline 1.
• In vitro studies support using a true cerumenolytic, such as a 10% solution of sodium bicarbonate, rather than an oil-based lubricant for disintegration of cerumen, with a longer period of treatment tending to be more efficacious 1.
• However, it is crucial to prioritize the child's safety and avoid using objects that can push wax deeper or cause injury, such as cotton swabs.
• If the child has ear tubes, ear pain, discharge, or if symptoms persist after treatment, it is essential to consult a healthcare provider.

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: ... children under 12 years: consult a doctor

For children, consult a doctor before using ear drops for wax removal, as the labels for both hydrogen peroxide (OTIC) 2 and carbamide peroxide (OTIC) 3 do not provide specific instructions for children under 12 years of age.

From the Research

Ear Drops for Wax Removal in Children

• The use of ear drops for wax removal in children is a common practice, with various types of ear drops available, including oil-based and water-based compounds 4.
• A study published in The Cochrane database of systematic reviews in 2018 found that the application of ear drops for five days may result in a greater likelihood of complete wax clearance than no treatment at all 4.
• The study compared different types of ear drops, including oil-based and water-based treatments, and found no evidence of a difference in efficacy between them 4.
• The study also found no evidence to show that using saline or water alone is better or worse than commercially produced cerumenolytics, or that using saline or water alone is better than no treatment 4.

Types of Ear Drops

• Oil-based ear drops, such as olive or almond oil, are commonly used for wax removal 4.
• Water-based ear drops, such as sodium bicarbonate or water itself, are also available 4.
• Other types of ear drops, such as carbamide peroxide and glycerol, are also used for wax removal 4.

Adverse Effects

• The study found that adverse effects, such as discomfort, irritation, or pain, were mild and reported in fewer than 30 participants across the seven studies that reported this outcome 4.
• There were no significant differences in adverse effects between the types of ear drops used 4.