Excess cerumen in the external ear canal commonly causes hearing loss and vertigo, contributes to infection and obscures visualization of the tympanic membrane. Removal of cerumen can be done manually or with irrigation, but these procedures are uncomfortable and may cause irritation or injury to the tympanic membrane. Ceruminolytic agents, or wax solvents, such as olive oil, sodium bicarbonate, glycerine, acetone, triethanolamine polypeptide, hydrogen peroxide and various forms of docusate sodium have been used. Singer and associates compared the ceruminolytic effects of a single brief application of docusate sodium, with or without irrigation, with application of the more commonly used triethanolamine polypeptide in a randomized, double-blind test.
Patients one year or older presenting to an emergency department with medical conditions requiring visualization of the ear canal were eligible for enrollment if the ear canal was partially or totally occluded by cerumen. Patients with known or suspected tympanic membrane perforation or overt ear infection were excluded. The physician applied 1 mL of the study solution, sodium docusate or triethanolamine polypeptide in the affected ear and the patient remained on his or her side with the affected ear upward for 10 to 15 minutes. The ceruminolytic agent was allowed to drain by gravity, and the physician took another look. If the tympanic membrane was still obscured, irrigation with lukewarm normal saline solution was performed and repeated once if necessary.
The tympanic membrane was visualized immediately in five (19 percent) of the 27 patients who received docusate sodium and in two (9 percent) of the 23 who received triethanolamine polypeptide. Although this difference was not significant, the added number of tympanic membranes that were visible after the first or second irrigation was significantly higher in the docusate sodium group. No adverse events were reported in members of either group.
The authors conclude that docusate sodium is superior to triethanolamine polypeptide as a ceruminolytic agent. This finding was even more pronounced in study subjects who were younger than five years.