II. Contraindications
III. Indications
- Acute Cerumen Impaction with pain or Hearing Loss
- Instill softening agents in ear for 7-14 days
- May require manual removal of residual debris
- Prior to a scheduled ear exam (start 2-3 weeks before)
- Chronic Cerumen Impaction
IV. Preparations: Water-based agents
-
Hydrogen Peroxide or Benzalkonium chloride (Zephiran)
- Mix 1:1 with diluted white vinegar
- Instill qd-bid for 4-14 days
- Acetic acid 2.5% (more effective in children)
- Sodium Bicarbonate 10% (more effective in children)
V. Preparations: Non-water and non-oil based agents
- Debrox drops (Carbamide Peroxide)
- Chlorine Salicylate and Glycerol (Earex Plus, Audax)
- Ethylene oxide polyoxypropylene glycol (Addax)
- Propylene glycol
- Chlorbutol 0.5%
VI. Preparations: Oil-based agents
- Arachis oil 57%, Chlorbutol 5%... (Cerumol)
- Arachis oil, camphor oil (Otocerol)
-
Mineral Oil or Almond Oil
- See protocol below
- Avoid olive oil (ineffective)
- Rodgers (2013) Practice Nursing
VII. Protocol: Clinic Cerumenolytic use prior to irrigation
- Instilled 15-30 minutes before irrigation
- Options
- Cerumenex drops (Triethanolamine) 10%
- Hydrogen Peroxide (3%)
- Water
- Saline (as effective as other agents above)
VIII. Protocol: Acute Cerumen Impaction - home program
- Instill several drops of any preparation listed above
- Repeat three times daily for 7-14 days
IX. Protocol: Chronic or recurrent Cerumen Impaction
- Perform on scheduled basis
- Three drops Mineral Oil or almond oil each ear (olive oil appears ineffective, see above)
- Three times daily
- Three weeks
- Three times per year
- After instilling drops
- Place cotton loosely in ear canal
- Memory aid
- Try performing at major holiday times
- Example: Easter, Labor day, Christmas
- Try instilling once per week
- Try performing at major holiday times