Cerumen Softening Agents

Aka: Cerumen Softening Agents, Ceruminolytic

1. Contraindications
   1. Tympanostomy Tubes
   2. Tympanic Membrane Perforation
2. Indications
   1. Acute Cerumen Impaction with pain or Hearing Loss
      1. Instill softening agents in ear for 7-14 days
      2. May require manual removal of residual debris
   2. Prior to a scheduled ear exam (start 2-3 weeks before)
   3. Chronic Cerumen Impaction
3. Preparations: Water-based agents
   1. Hydrogen Peroxide or Benzalkonium chloride (Zephiran)
      1. Mix 1:1 with diluted white vinegar
      2. Instill qd-bid for 4-14 days
   2. Acetic acid 2.5% (more effective in children)
   3. Sodium Bicarbonate 10% (more effective in children)
4. Preparations: Non-water and non-oil based agents
   1. Debrox drops (Carbamide Peroxide)
   2. ChlorineSalicylate and Glycerol (Earex Plus, Audax)
   3. Ethylene oxide polyoxypropylene glycol (Addax)
   4. Propylene glycol
   5. Chlorbutol 0.5%
5. Preparations: Oil-based agents
   1. Arachis oil 57%, Chlorbutol 5%... (Cerumol)
   2. Arachis oil, Almond oil, camphor oil (Otocerol)
   3. Olive oil, Mineral Oil, Baby Oil, or Almond Oil
      1. See protocol below
6. Protocol: Clinic cerumenolytic use prior to irrigation
   1. Instilled 15-30 minutes before irrigation
   2. Options
      1. Cerumenex drops (Triethanolamine) 10%
      2. Hydrogen Peroxide (3%)
      3. Water
      4. Saline (as effective as other agents above)
7. Protocol: Acute Cerumen Impaction - home program
   1. Instill several drops of any preparation listed above
   2. Repeat three times daily for 7-14 days
8. Protocol: Chronic or recurrent Cerumen Impaction
   1. Perform on scheduled basis
      1. Three drops olive oil or baby oil each ear
      2. Three times daily
      3. Three weeks
      4. Three times per year
   2. After instilling drops
      1. Place cotton loosely in ear canal
   3. Memory aid
      1. Try performing at major holiday times
         1. Example: Easter, Labor day, Christmas)
      2. Try instilling once per week
9. References
   1. Browning (2006) Clin Evid 14: 650-8
   2. Grossan (2000) Geriatrics 55:80-6
   3. Hand (2004) Br J Gen Pract 54:862-7
   4. McCarter (2007) Am Fam Physician 75:1523-30