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Ear Wax Softening / Cerumenolytic Pregnancy: Safe — topical application; no systemic absorption; ear wax removal is appropriate in pregnancy

Urea Hydrogen Peroxide Ear Drops

Brand names: Exterol, Otex, Earex Plus

Adult dose

Dose: 5 drops
Route: Otic
Frequency: Twice daily for 3–4 days before irrigation or syringing
Max: 5 drops per ear twice daily
Cerumenolytic for ear wax removal before irrigation. Urea hydrogen peroxide (5%) releases oxygen on contact with cerumen, mechanically disrupting the wax structure. Can also be used as sole treatment for mild wax impaction. Warm the bottle in hands before use. Tilt head and maintain position for several minutes.

Paediatric dose

Dose: 5 drops drops/kg
Route: Otic
Frequency: Twice daily for 3–4 days
Max: 5 drops per ear twice daily
BNFc: licensed in children — same dose as adults. Ensure TM is intact before use.

Dose adjustments

Renal

Not applicable (topical — negligible systemic absorption)

Hepatic

Not applicable

Paediatric weight-based calculator

BNFc: licensed in children — same dose as adults. Ensure TM is intact before use.

Clinical pearls

  • NICE CKS Ear Wax (2022): cerumenolytics (olive oil, sodium bicarbonate, urea hydrogen peroxide) recommended before ear irrigation — reduces treatment failure rate
  • Olive oil is an effective, low-cost alternative cerumenolytic — equivalent efficacy in RCTs; often preferred by patients as more natural
  • Technique: warm drops to body temperature (hold bottle in palm for 2 minutes), tilt head, instil drops, remain reclined for 5–10 minutes to maximise contact time
  • Ear irrigation (electronic or manual syringing): should be performed by trained practitioner; CONTRAINDICATED with perforation, history of ear surgery, cholesteatoma, or active infection
  • Microsuction is the gold-standard for wax removal — preferred over irrigation; avoids water in the ear canal; safe with most ear conditions
  • Annual ear wax production averages ~15 mg; self-cleaning mechanism (epithelial migration from centre of TM outward) fails in some patients — ear canal anatomy, cotton bud use, hearing aid use all contribute to impaction

Contraindications

  • Perforated tympanic membrane
  • Acute otitis media or otitis externa (active infection)
  • Grommets (tympanostomy tubes) in situ
  • Previous ear surgery
  • Hypersensitivity

Side effects

  • Transient bubbling/fizzing sensation (expected — oxygen release)
  • Transient discomfort
  • Transient dizziness (caloric effect of cold drops — warm bottle first)
  • Local irritation (rare)

Interactions

  • None clinically significant

Monitoring

  • Symptom resolution
  • TM inspection after wax clearance

Reference: BNFc; BNF 90; BNFc; NICE CKS Ear Wax (2022); BSHAA Earwax Consensus Statement 2018. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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