Clinical inquiries. What is the best treatment for impacted cerumen?

EVIDENCE SUMMARY In studies that evaluated onetime softening in the office to ease or eliminate the need for irrigation, a presoak with docusate sodium (Colace) was most effective, although its effects were not compared with those of water. Both triethanolamine (Cerumenex) and olive oil were the next most effective treatments. Carbamide peroxide (Debrox, Murine Ear) was least effective (see Table and Table W1*). In 1 small, carefully done study of ear candles, more candle wax was added than earwax was removed in the 8 ears tested. In studies that evaluated 3 to 14 days of home ceruminolysis to obviate or ease irritation, 5% urea hydrogen peroxide in glycerol was most effective. Sterile water, sodium bicarbonate in glycerol, 2% acetic acid (VoSoL, Domeboro), ethylene oxide polyoxypropylene (Addax), and acpd (arachis oil, chlorobutanol, p-dichlorobenzene [Cerumenol]) were all of equal efficacy. All were more effective than no treatment. Notably, 5% of cases resolved completely and 26% became moderately clear after 5 days of no treatment (Table W2*). No direct comparisons exist of same-day in-office softening followed by irrigation or disimpaction against home softening followed by irrigation and manual disimpaction. Until more placebo-controlled data are generated, recommendations should be based on relative safety and on the direct comparison trials within each strategy. Complications of irrigation include otitis externa, perforation, canal trauma, pain, cough, tinnitus, vertigo, otitis media, treatment failure, and time consumption. Harm done by wax softeners is minimal.