Ear drops to remove earwax: what works and is it worth the bother?

Cochrane UK’s Sarah Chapman blogs about ear scoops, leek juice, and the latest Cochrane evidence on earwax removal. Which ear drops are best and is using drops better than doing nothing? 

Water, vinegar, soda, honey, carbolic acid, glycerine, olive oil, verdigris, borax, leek juice. All these things have been recommended, down the ages, to soften and remove earwax. We’ve abandoned some of these, including carbolic acid, a popular disinfectant in the 19thcentury, but also poisonous, and leek juice, mentioned by Roman encyclopaedist Aulus Cornelius Celsus in his 1stcentury medical work, De Medicina. Celsus waxed lyrical on methods of removal, and the process he describes, of instilling something to soften the wax and washing it out with tepid water, is familiar to us today, along with the mechanical removal of softened wax with an instrument. Celsus’ instrument of choice was an ear scoop, and Henry VIII made a present of a golden ear scoop pendant to Anne Boleyn (some time before he decided to remove her ears, along with the rest of her head).

historic medicine bottles

Some of the ear drops used to soften wax have been used for centuries, but is one better than another?

Earwax is useful

According to The Woman’s Book, published in 1911, which claims to contain ‘everything a woman ought to know’, earwax should never be allowed to accumulate in the ears (Jack and Strauss, 1911). But earwax (cerumen) is part of the ear’s self-cleaning mechanism, and usually works its way out without causing problems.

It’s even been put to uses that seem very strange to us now. It has been recommended for strengthening nails, for example; for healing wounds (mixed with walnut oil and boiled to make a balsam) and curing colic (taken in drink). Wax taken from a dog’s left ear and hung round the sick person’s neck would cure fever or fits, according to Albertus Magnus’ Boke of Secretes(1560). Applied to the nostrils, it could induce sleep (Read, 2016). Fast forward to our own times; we know that the two types of earwax, wet and dry, are genetically determined, and anthropologists find it useful for tracking ancient migration patterns (Goldman, 2016).

Removing earwax

Before we laugh too loudly at the folly of our forebears, let’s remember that in 21stcentury Britain (and elsewhere), some people are paying good money to have candles put into their ears and lit, believing that this will draw the wax out. There is no evidence that this is an effective method of wax removal, it can be dangerous, and it’s right up there in terms of nonsense treatments with necklaces of dog earwax (US Food and Drug Administration, 2018).

Earwax can cause problems when it obstructs the ear canal, and we may then need to do something to help its removal. Ear drops are a common method and whilst the application of some sort of liquid into the ear is often recommended prior to syringing, this may be enough on its own to allow the softened wax to pass out of the ear.  Liquids suggested for this use include oils (almond or olive) and oil-based compounds, water-based compounds, or water by itself.

The latest evidence

An updated Cochrane Review published this week, brings together the best available evidence on which liquid might be best, and whether using something is better than nothing at all. The drops tested included water, saline (salty water), other water-based drops, or oil-based drops. There were 10 studies, but only six (with 491 ears belonging to 360 adults and children) had data on complete wax clearance.

I’m imagining lining up all those writers from past centuries, clutching their wax removal liquids of choice, and telling them that modern science has delivered the answer, and the answer is….”.

Well, the thing is, we still don’t know what’s best to use. All but one of the studies compared different types of drops, but the lack of high quality evidence leaves us not knowing whether one type is better than another.

Nor are we certain that it’s worth using anything at all. Just one study compared using water or saline drops for five days with doing nothing. Whilst this evidence suggests that using drops may increase the likelihood of the ears becoming completely clear of wax, there is a very wide range of possibility for the size of the effect. Without treatment, on average 5 in 100 people will have complete clearance of wax, spontaneously. It is estimated that with drops this may increase this to 6 in 100, or as many as 84 in 100.

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We still don’t know what’s best to use to soften earwax

Where does this leave us?

The Review authors note that using any of the drops used to soften earwax seem to be safe and well tolerated. Although adverse effects can’t be ruled out, where hypersensitivity might occur with some active components of drops, that wouldn’t happen with water or saline.

They also comment that research into the best ways to manage people with earwax that is causing problems “should consider the whole patient pathway, of which the use of eardrops is only one part”.

Any future trials, they urge, need to be better ones. Where’s Cerulus when we need him? He had so much to say about earwax, and could have been just the person to put out a call for trial participants. Maybe “Friends, Romans, countrymen, lend me your ears…”

Join in the conversation with @SarahChapman30 @CochraneUK @CochraneENT @martinjburton or leave a comment on the blog.

References.

Sarah Chapman has nothing to disclose.



Ear drops to remove earwax: what works and is it worth the bother? by Sarah Chapman

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

13 Comments on this post

  1. Avatar

    ok, thanks for advice

    jonathan search / Reply
  2. Avatar

    Key results: Only one study compared using drops with an active ingredient to not using drops at all. The drops may help increase the proportion of ears cleared of wax from 1 in 20 (if you do nothing) to about 1 in 5 (if you use drops).

    Wiseacre / Reply
  3. Avatar

    I really can’t understand how someone could write such an article, without thinking, is there any point to this ?
    I can’t quite grasp what the intention of the piece was ? If you don’t have any useful information, then sum it up briefly. Better yet, choose a different topic.

    Joe / Reply
  4. Avatar

    Hi
    I first noticed my tinnitus about 30yrs ago and i think it causes a build up of wax which doesn’t help. In the last 5 years ive wasted about £100 on useless gadgets & liquids. I have hard stubborn wax deep in ears & my left ear is worse (i can tell by pinching my nose & blowing which temporarily improves hearing in right ear). Any impartial advice would be appreciated.
    thanks

    Jonathan Search / Reply
    • Avatar

      dont waste any more money on these crappy products, they never work. a much better option is just to go to your local audiologists who will usually offer 2 options:irrigation where theyre cleared with warm water or microsuction this is where the wax is sucked out with a tiny hose, both methods are equally effective.

      i believe specsavers charge about £55 and boots £50 but you may find an independent whos even cheaper, the place i go only charges £40

      gascat / (in reply to Jonathan Search) Reply
  5. Avatar

    Thats 5 mins of my life I’ll never get back, was looking for some ideas of best products to buy, not bloody war & peace/history lesson; what a waste of time

    James / Reply
  6. Avatar

    I was hoping for a list of what’s useful and what isn’t. The writing is witty, but it’s not helpful.

    Ella / Reply
  7. Avatar

    Summary

    “I don’t know.

    Research isn’t conclusive

    Not sure”

    D Frame / Reply
  8. Avatar

    I am a pro violinist and have a moderate hearing loss in the upper range although the violin is so close to your ears that it does not prevent me in my work. Hearing aids are no good for playing as they distort the sound. I tried olive oil drops as I had a problem with hardened earwax rattling in my head but it is so messy and the oil seems to get everywhere. Earex after just one treatment improved the sound of my violin’s high notes so I will continue with that.

    Ed Jones / Reply
  9. Avatar

    Had my ears shrynged last week but it’s made no difference my ear canal is very tiny what can I do to dissolve it

    Jane Bowden / Reply
  10. Avatar

    Totally unhelfpul. Earex used to be effective for me but has changed its composition to a stick glycerol + hydrogen peroxide mix that hurts, makes me more deaf, and doesn’t remove the wax. I compared it with a few drops of olive oil – the latter made a noticeable improvement in my hearing in two days. Why write all that blather about the history of earwax and not say upfront that none of the studies undertaken used a scientific approach.

    Katharine Larkin / Reply
    • Sarah Chapman

      We hope our blogs are quick for people to read and get the information they want, but we are looking at ways to make the key information even clearer. We do aim to make sure we talk about how reliable the evidence is and highlight gaps – important to know.
      I’m glad you have found something that helps you.
      Best wishes,
      Sarah Chapman [Editor].

      Sarah Chapman / (in reply to Katharine Larkin) Reply

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