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Earwax - Management
Which ear drops should I prescribe?

  • CKS recommends use of sodium bicarbonate 5% ear drops, sodium chloride 0.9%, olive oil, or almond oil.
  • Choice of ear drops may be influenced by what the person has already tried, and what has worked in the past.
  • Sodium chloride 0.9% is not available as a proprietary ear drop product. However, sodium chloride 0.9% nasal drops can be prescribed for use in the ear (off-label use).
  • Do not prescribe almond oil ear drops to anyone who is allergic to almonds.
Basis for recommendation
  • Evidence is very limited regarding the choice of ear drops to treat earwax.
    • Two systematic reviews have concluded that using ear drops of any kind to remove impacted earwax is better than no treatment. However, there is no evidence to provide a preference of one particular wax softener to another.
    • This has been supported by a more recent systematic review and economic evaluation of different methods of earwax removal, which found that although softeners are effective, which specific softeners are most effective remains uncertain [Clegg et al, 2010].
    • CKS therefore recommends the use of either sodium bicarbonate 5%, sodium chloride 0.9%, olive oil, or almond oil.
  • Many proprietary preparations contain organic solvents (e.g. Cerumol®). These preparations are not recommended because they may cause irritation and inflammation of the external ear canal, and do not offer any clear advantages over other products [Somerville, 2002].
  • Ear drops soften wax and aid removal. There are two kinds of earwax solvents: oil based and water based [Burton and Doree, 2003].
    • Oil-based ear drops are thought to work by dissolving earwax.
    • Water-based ear drops improve water miscibility.

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