Debrox Dosage for Cerumen Impaction
For adults and children over 12 years: tilt head sideways, place 5 to 10 drops into the affected ear twice daily for up to 4 days, keeping the drops in the ear for several minutes by maintaining head tilt or placing cotton in the ear. 1
Exact Dosing Instructions
- Tilt the head sideways with the affected ear facing upward 1
- Instill 5 to 10 drops of carbamide peroxide (Debrox) into the ear canal 1
- Do not insert the applicator tip into the ear canal 1
- Keep drops in the ear for several minutes by maintaining head tilt or placing cotton in the ear 1
- Apply twice daily for up to 4 days 1
- After 3-5 days of treatment, any remaining wax may be removed by gently flushing the ear with warm water using a soft rubber bulb ear syringe 1, 2
Age-Specific Restrictions
- Children under 12 years: consult a doctor before use 1
- Children under 3 years: cerumenolytic drops are contraindicated; manual removal by a trained clinician is the primary treatment option 2
Expected Efficacy
After 5 days of twice-daily carbamide peroxide drops, approximately 22% of treated ears achieve complete cerumen clearance without irrigation, compared with only 5% clearance in untreated ears 3. This modest but meaningful benefit establishes drops as appropriate first-line therapy 3.
Absolute Contraindications—Do Not Use If:
- Perforated tympanic membrane (current or prior) 2, 3, 1
- History of ear surgery unless cleared by an otolaryngologist 2, 3
- Tympanostomy tubes in place 2, 3
- Active otitis externa or ear infection 2, 3
- Ear canal stenosis or exostoses 2, 3
Modifying Factors Requiring Caution
Patients with the following conditions may use drops but require closer monitoring and may need specialist referral if complications arise 2, 3:
- Anticoagulant therapy or coagulopathy
- Immunocompromised state
- Diabetes mellitus
- Prior head/neck radiation therapy
In diabetic or immunocompromised patients, avoid subsequent irrigation with tap water to prevent malignant otitis externa 3.
Treatment Algorithm When Drops Alone Are Insufficient
- Days 1-4: Apply carbamide peroxide drops twice daily as directed 1
- Day 5: If impaction persists, perform irrigation with body-temperature water (37°C/98.6°F) to avoid caloric-induced vertigo 2, 3
- If irrigation fails: Refer for manual removal by a clinician with specialized equipment 2, 3
The most cost-effective protocol is cerumenolytic drops followed by self-irrigation at home, which is more effective than either treatment alone 2, 3.
Critical Safety Warnings—What NOT to Do
- Never use cotton-tipped swabs: they push wax deeper and can cause canal laceration, tympanic membrane perforation, or ossicular dislocation 2, 3
- Never use ear candling: no evidence of efficacy and can cause burns, ear canal occlusion, and tympanic membrane perforation 2, 3
- Avoid home oral jet irrigators: lack safety and efficacy data 2, 3
Post-Treatment Assessment
- Document complete resolution of the cerumen impaction at the conclusion of treatment 2, 3
- If symptoms persist despite clearance, evaluate for alternative diagnoses such as acute otitis media 2, 4
- Only treat symptomatic impaction or when ear examination is needed—do not routinely treat asymptomatic cerumen 2, 3
Common Pitfall
The FDA label states "up to four days" 1, but the American Academy of Otolaryngology-Head and Neck Surgery guidelines recommend 3-5 days of cerumenolytic pretreatment before considering irrigation or other interventions 2, 3, 4. In clinical practice, extending treatment to 5 days before irrigation is supported by guideline evidence and increases the likelihood of successful wax softening 2.