Letters to the Editor
Alternatives to Ear Syringing for Removal of Earwax
Am Fam Physician. 2004 Apr 15;69(8):1860-1863.
The following editor's note by Anne D. Walling, M.D., appeared with a “Tips from Other Journals” in the February 15, 2003 issue of American Family Physician.1 The “Letter to the Editor” that follows was chosen from numerous responses we received.
editor's note: Ear syringing is a very common procedure in nursing homes—and the patients hate it! I have heard rumors of removing ear-wax in children by using liquid stool-softening agents but cannot find references or colleagues who have used this method in adults. If anyone knows a better way to remove earwax, please let us know.—a.d.w.
1. Walling AD. How effective is ear syringing in improving hearing? [Tips]. Am Fam Physician. 2003;67:870.
to the editor: For many years, I have used a mixture of the contents of one capsule of docusate calcium (Surfak, 240 mg) and a few mL of water for removing earwax. I fill the ear canal with this mixture, have the patient lie still for at least 30 minutes, and then irrigate the ear with warm water. This treatment is usually successful. I do not use the docusate calcium solution for anything but removing cerumen.
IN REPLY: Ask and ye shall receive! We would like to thank everyone who sent suggestions on earwax removal. Judging from the number of responses, this is a common and stubborn problem. All of the responses demonstrate that doing unglamorous things well is one hallmark of a being a good family physician.
Earwax removal is performed for various reasons, including hearing loss, sensation of ear blockage, and visualization of the tympanic membrane. The most common clinical practice is ear syringing, which is limited by patient tolerance and complications. Although syringing is considered the clinical standard, there are no high-quality studies comparing syringing with other methods or no treatment.1
Wax softeners and ceruminolytics are used to improve the success and tolerability of irrigation. They also can be used as solo agents for home therapy. However, studies evaluating ceruminolytics have used inconsistent methods. Thus, there is no clear evidence that one type of softener is superior to another.1,2 Furthermore, most studies lack a “no treatment” group, so it is impossible to discern more than relative efficacy in most cases.1 No studies exist comparing home and office treatment.3
One promising treatment is liquid docusate sodium (Colace). It is more effective than triethanolamine (Cerumenex) for augmenting irrigation. In one study,4 instilling 1 mL of docusate sodium fifteen minutes before irrigation allowed tympanic membrane visualization in 81 percent of study participants. However, another study5 did not find either treatment better than a normal saline control. The accompanying table lists other softening options. For those seeking more information on this common clinical problem, we recommend the following reading (Aung T, Mulley GP. Removal of ear wax. BMJ 2002;325:27, and references 1 and 2).
Options For Cerumen Removal
Options For Cerumen Removal
Ear jet irrigator
Ceruminolytics or softeners
Arachis oil, chlorobutanol, p-dichlorobenzene (Cerumenol)
Carbamide peroxide (Debrox)
Docusate sodium (Colace)
Ethylene oxide polyoxypropylene (Addax)
Oil (olive or mineral)
Sodium bicarbonate in glycerol
2 percent acetic acid
Water, normal saline
1. Browning G. Wax in ear. Clin Evid. 2002;7:490–7.
2. Burton MJ, Doree CJ. Ear drops for the removal of ear wax. Cochrane Database Syst Rev. 2003;3:CD004400.
3. Wilson SA, Lopez R. What is the best treatment for impacted cerumen?. J Fam Pract. 2002;51:117.
4. Singer AJ, Sauris E, Viccellio AW. Ceruminolytic effects of docusate sodium: a randomized, controlled trial. Ann Emerg Med. 2000;36:228–32.
5. Whatley VN, Dodds CL, Paul RI. Randomized clinical trial of docusate, triethanolamine polypeptide, and irrigation in cerumen removal in children. Arch Pediatr Adolesc Med. 2003;157:1181–3.
editor's note: I am particularly grateful to those who referred to or sent copies of the article by Singer and colleagues (Ann Emerg Med 2000;36:228-32). It took some persuasion, but the staff at the nursing home finally agreed to use docusate sodium (Colace), and my elderly patients are grateful. They now complain that they can hear me but can't understand my Scottish accent!-A.D.W.
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