An ex vivo comparison of over-the-counter cerumenolytics for ear wax

Background: Ear wax (cerumen) impaction is a common reason why patients present to general practitioners (GPs) and ear, nose and throat (ENT) specialists. However, there is no consensus on the effectiveness of the variety of cerumenolytics commonly available. Currently, there are no investigations on the effectiveness of cerumenolytics against cerumen of varying consistencies. Methods: This prospective ex vivo study analysed cerumen from twelve patients who visited an Ear, Nose Throat clinic for impaction over a 1-month period. Four separate samples of cerumen of varying consistency ratings (soft, medium or hard) were compared. A punch biopsy was used to standardise the test sample size of the cerumen, which was placed in a tube containing 0.5 mL of 1 of 10 different cerumenolytics. Agents used were Waxsol®, hydrogen peroxide, Aqua Ear®, Earclear®, CleanEars®, olive oil, Cipro®HC, Sofradex®, Co-phenylcaineTM Forte and sterile water. Photo documentation of the cerumen samples was performed at 1, 2, and 5 minutes. Outcome measures were based on dissolving and softening scales. Results: Water-based cerumenolytics resulted in the greatest extent of cerumen dissolvability and softening. Sterile water had the greatest effect. Oil-based agents had limited effect. Non-water-/non-oil-based cerumenolytics were comparable with water-based agents in dissolving and softening the cerumen across all consistencies. Conclusions: Cerumenolytic agents commonly available in most Australian pharmacies were compared against cerumen of different consistencies. Water-based agents were found to be the most effective. Oil-based cerumenolytics commonly used in the outpatient setting were found to be ineffective. Sterile water was the most effective agent across most consistencies, raising questions about the worth of expensive cerumenolytic products. Cerumen consistency did not significantly alter the effectiveness of the cerumenolytics.