Urea Hydrogen Peroxide Ear Drops
Brand names: Exterol, Otex, Earex Plus
Urea hydrogen peroxide ear drops are a topical cerumenolytic instilled into the external auditory canal to soften and help disperse impacted ear wax.
Adult dose
Paediatric dose
Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.
Contraindications
- Do not use if the eardrum is known or suspected to be damaged
- Cases of dizziness
- Any other ear disorder, current or past — pain, discharge, inflammation, infection or tinnitus
- After ill-advised attempts to dislodge wax using fingernails, cotton buds or similar implements — 'such mechanical efforts can cause the ear's delicate inner lining to become damaged, inflamed or infected, whereupon the use of ear drops can be painful'
- Inadvisable to use within 2 to 3 days of syringing
- History of ear problems, unless under close medical supervision
- Sensitivity to any of the ingredients
Side effects
- Mild, temporary effervescence in the ear, due to the release of oxygen
- Irritation or pain — stop usage if this occurs
- Aggravation of the painful symptoms of excessive ear wax, including some loss of hearing, dizziness and tinnitus
- Unpleasant taste (very rarely reported)
Monitoring
- §4.8: if irritation or pain occurs, stop using the drops
- §4.8: 'If patients encounter any of these problems, or if their symptoms persist or worsen, they should discontinue treatment and consult a doctor.'
- §4.4: 'Keep Otex away from the eyes. For external use only.' Replace the cap after use
- §4.5: 'Otex should not be used at the same time as anything else in the ear.'
Clinical monograph
How it works
On contact with cerumen the preparation releases oxygen and effervesces, mechanically breaking up and loosening the wax to aid its softening and removal.
Prescribing in practice
- Do not use when the eardrum is known or suspected to be perforated, or in the presence of acute ear infection or discharge.
- It is for external-ear (auricular) use only and is intended for short courses to soften wax, sometimes ahead of irrigation.
- Transient effervescence, a bubbling sensation, mild irritation or temporary dulling of hearing can occur after instillation.
Monitoring
No systemic monitoring is required; review whether the wax has cleared and check for any local irritation or pain.
Counselling the patient
- You may feel fizzing or bubbling in the ear, which is expected.
- Lie with the treated ear uppermost for a short time after putting the drops in.
- Stop and seek advice if you get ear pain, discharge or it does not improve.
Evidence & guidelines
Cerumenolytic ear drops are a standard first-line measure for softening impacted wax, often before irrigation if needed.
Reference: NICE CKS Ear Wax (2022); BSHAA Earwax Consensus Statement 2018; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).
Related
Curated clinical cross-links plus same-class fallbacks.
- Adult Upper Airway Obstruction (Stridor) · DAS 2015 unanticipated difficult airway; RCEM
- Epistaxis Management · ENT-UK / NICE
- Acute Otitis Media · NICE NG91 2018
- Tonsillitis and Sore Throat · NICE NG84 2018
- Benign Paroxysmal Positional Vertigo · NICE CG124 / AAO-HNS Guidelines
- Acute Rhinosinusitis · NICE NG79 2017 / EPOS 2020