Best Drops for Earwax Removal

It's about time, but some researchers actually put to the test to try and determine what is the best solution to dissolve/remove earwax.

The verdict was... WATER!

Better than mineral oil, liquid colace, and over-the-counter cerumenolytics (ie cerumol). Hydrogen peroxide was not evaluated.

How was this result determined?

Using guinea pigs, the researchers first tested whether each of these substances were safe should a hole in the eardrum be present allowing for the solution to enter the middle ear space. Colace was found to be the most ototoxic (meaning, potential for permanent hearing loss if a ear tube or a hole in the eardrum is present). Mineral oil and saltwater (normal saline) was found not to be toxic.

Next, they determined which substance provided the greatest degree of cerumen dissolving ability. Each substance was added to a cylinder filled with earwax for 5 minutes. They than determined how much weight was required for a 25G needle to fully penetrate through the earwax.

Water was found to provide far superior earwax dissolving ability compared to all other substances tested. Not surprising given water is considered the best universal solvent used to clean everything from dishes to cars to buildings.

These findings were confirmed in humans as well in later studies [link].

What is the take-home message?

Given saltwater/water is completely safe for hearing even if there is a hole in the eardrum along with superior earwax dissolving ability, it seems to be a no-brainer to instruct patients with lots of earwax to use water or saline to get rid of earwax. I personally recommend patients with chronic earwax buildup to flush the ear with an earwax syringe using warm water.

References:
Ototoxicity of intratympanic docusate sodium and mineral oil in the Guinea pig. Otolaryngol Head Neck Surg. 2012 Mar;146(3):455-60. Epub 2011 Nov 18. 

  
Randomized, placebo-controlled evaluation of Cerumenex and Murine earwax removal products. Arch Otolaryngol Head Neck Surg . 2004 Oct;130(10):1175-7. doi: 10.1001/archotol.130.10.1175. 

Comparison of the Cerumenolytic Activities of New and Currently Used Agents. Nose Throat J. 2021 Jan 29;145561320986060. doi: 10.1177/0145561320986060. Online ahead of print.