Earwax Removal Agents: Review article

Abstract

Earwax (cerumen) is a natural secretion essential for ear health, but its impaction can lead to symptoms such as hearing loss, pain, and discomfort. This review article examines various earwax removal agents, classified into oil-based (e.g., olive oil, mineral oil, almond oil), water-based (e.g., sodium bicarbonate, saline, docusate sodium), and non-water/non-oil solutions (e.g., carbamide peroxide, glycerol, triethanolamine polypeptide). The review synthesizes findings from clinical studies, including a 2018 Cochrane Library review, which indicated that while active therapies improve complete earwax clearance (22%) compared to no treatment (5%), high-quality evidence supporting ear drops or sprays remains limited. Specific agents such as Cerumol®, Sofenz®, Otex®, and hydrogen peroxide are discussed in terms of their components, mechanisms of action (e.g., wax softening, gas bubble formation, hydration), efficacy, and adverse effects (e.g., irritation, pain). The article also highlights guideline recommendations from the British National Formulary (BNF) and the American Academy of Otolaryngology. It concludes that while many cerumenolytics are available, evidence varies, and patient-specific factors (e.g., eardrum perforation, age, infection) must guide treatment choices. Further well-designed randomized controlled trials are needed to address current evidence gaps.