Irrigation can be attempted alone or with cerumenolytic pre-treatment. Put three drops into the affected ear at bedtime for three or four daysĪrachis oil, 57% chlorbutol, 5% paradichlorobenzene, 2%, and turpentine oil, 10% (e.g., Cerumol)įill affected ear with 5 mL twice daily for two or three days Put four drops into the affected ear twice daily for up to four days Not all brands and formulations are available in the United StatesĪlmond, arachis, or rectified camphor oil (e.g., Otocerol, Earex) Put three drops into the affected ear twice daily for four days
CLAEN EAR PRACTICE PLUS
Put five to 10 drops into the affected ear twice daily for up to seven daysĬholine salicylate plus glycerol (e.g., Earex Advance) ethylene oxide polyoxypropylene glycol (Addax) propylene glycol chlorbutol, 0.5% If irrigation is attempted without softening and is ineffective after the first attempt, instill water and wait 15 minutes before repeating irrigation Triethanolamine polypeptide oleate condensate, 10%Ĭan be irritating to the ear canal and should not be used for a prolonged period Soften cerumen before irrigation or as an alternative to irrigationįill affected ear with 2 to 3 mL 15 to 30 minutes before irrigation, or alternatively for three to 14 days at home with or without irrigation If not completely removed, bubbling may interfere with ability to visualize tympanic membrane In one study, one-fifth of tympanic membranes were visualized without irrigationįill affected ear canal 15 to 30 minutes before irrigation
More effective in children than in adultsįill affected ear canal with 1 mL 15 to 30 minutes before irrigation Persistent symptoms despite resolution of the impaction should also prompt further evaluation for an alternative diagnosis.įill affected ear with 2 to 3 mL twice daily for up to 14 days If multiple attempts to remove the impacted cerumen-including a combination of treatments-are ineffective, clinicians should refer the patient to an otolaryngologist. Cotton-tipped swabs, ear candling, and olive oil drops or sprays should be avoided. Home irrigation with a bulb syringe may be appropriate for selected adults.
CLAEN EAR PRACTICE MANUAL
Effective treatment options include cerumenolytic agents, irrigation with or without cerumenolytic pretreatment, and manual removal. Patients with coagulopathies, hepatic failure, thrombocytopenia, or hemophilia, and those taking antiplatelet or anticoagulant medications, should be counseled about the increased risk of bleeding in the external auditory canal when cerumen is removed. Cerumen should also be removed when it limits examination in patients who cannot communicate their symptoms, such as those with dementia or developmental delay, nonverbal patients with behavioral changes, and young children with fever, speech delay, or parental concerns.
However, cerumen should be removed when it causes symptoms (e.g., hearing loss, itching, pain, tinnitus) or prevents assessment of the external auditory canal, the tympanic membrane, or audiovestibular system. Cerumen production is a normal and protective process for the ear canal.
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