AgentUseDosingComment
Water-based
10% Triethanolamine polypeptide oleate condensateSoften cerumen before irrigationFill affected ear canal 15 to 30 minutes before irrigationCan be irritating to the ear canal and should not be used for a prolonged period
Docusate sodiumSoften cerumen before irrigationFill affected ear canal with 1 cc 15 to 30 minutes before irrigationIn one study, one fifth of tympanic membranes were visualized without irrigation22
3% Hydrogen peroxideSoften cerumen before irrigationFill affected ear canal 15 to 30 minutes before irrigationIf not completely removed, bubbling may interfere with ability to visualize tympanic membrane
2.5% Acetic acidHome treatment of impacted cerumenFill affected ear with 2 to 3 cc twice daily for up to 14 days22 More effective in children than in adults22
10% Sodium bicarbonateSoften cerumen before irrigation or as an alternative to irrigationFill affected ear with 2 to 3 cc 15 to 30 minutes before irrigation, or alternatively for three to 14 days at home with or without irrigation16,21 More effective in children than in adults22
Water or salineSoften cerumen before irrigationIf irrigation is attempted without softening and is ineffective with the first irrigation attempt, instill water and wait 15 minutes before repeating irrigation20
Non–water-based/non–oil-based
Carbamide peroxide (Debrox)Soften cerumen before irrigation or as an alternative to irrigationPut five to 10 drops into the affected ear twice daily for up to seven days
50% Choline salicylate and glycerol (e.g., Earex Plus, Audax); ethylene oxide polyoxypropylene glycol (Addax); propylene glycol; 0.5% chlorbutolSoften cerumen before irrigation or as an alternative to irrigationPut three drops into the affected ear twice daily for four daysNot all brands and formulations are available in the United States
Oil-based
57.3% Arachis oil, 5% chlorbutol, 2% paradicholorbenzene, 10% oil of turpentine (e.g., Cerumol)Soften cerumen before irrigation or as an alternative to irrigationFill affected ear with 5 cc twice daily for two to three daysNot all brands and formulations are available in the United States
Arachis oil, almond oil, rectified camphor oil (e.g., Otocerol, Earex)Soften cerumen before irrigation or as an alternative to irrigationPut four drops into the affected ear twice daily for up to four daysNot all brands and formulations are available in the United States
Olive oil, almond oil, or mineral oilSoften cerumen before irrigationPut three drops into the affected ear at bedtime for three or four days