I read Dr. Michelle Lin's Post-It Pearl in the December issue, and having heard this touted repeatedly over the years, I felt compelled to respond. (“Colace for Ear Cerumen,” EMN. 2019;41:5; http://bit.ly/3831uSz.)
In dealing with impacted cerumen, it's important to remember that ear wax is indeed wax and is poorly soluble in water or water-based solutions. It is, however, quite soluble in oil, and it's been my experience that mineral oil is a much more effective and certainly more cost-effective cerumenolytic to utilize prior to attempted irrigation. In fact, I have kept a bottle of baby oil in my ED for years for use in just such situations, typically with great success.
My usual technique is to fill the affected auditory canal with a few drops, have the patient remain in lateral decubitus for 15-20 minutes to allow the oil to soften the cerumen. Then utilizing a 20-30 mL syringe and a 20-gauge catheter, I forcefully irrigate the canal with lukewarm tap water (critical to avoiding an inadvertent caloric test), aiming the stream at any obvious gaps between the cerumen and the canal wall until canal patency is achieved. Not uncommonly, the cerumen impaction is expelled as a large plug.
As a therapeutic agent, baby oil is readily available, dirt cheap, and highly effective. When I discharge patients after miraculously restoring their hearing, I typically suggest that they perform a similar process periodically at home to prevent symptomatic reaccumulations, hopefully saving them (and us) future trips to the ED for recurrent episodes.
Michael S. Omori, MD
Timaru, New Zealand