Cerumenolytic

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Cerumenolytic
Drug class
Cerumenolytic used in right ear.jpg
Hydrogen peroxide, a common cerumenolytic, bubbles after being administered into a person's ear.
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A cerumenolytic is an ear wax (cerumen) softening agent. Common cerumenolytics such as hydrogen peroxide and hydrogen peroxide - urea (also called carbamide peroxide) are topical preparations used to facilitate the removal of ear wax. Their side effects tend to be mild, including ear discomfort, transient loss of hearing, dizziness, and local irritation.

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Medical uses

Cerumenolytics are used to soften and break up ear wax. Using a cerumenolytic can reduce the need for flushing the ear with irrigants for wax removal. Additionally, cerumenolytics can also facilitate the manual removal of ear wax. [1] Overall, all cerumenolytics are considered to be equivalent in efficacy. [2] Cerumenolytics are administered directly into the ear, which is a form of topical administration that can be specified as "ototopical." [3] [4] Generally, the use of a cerumenolytic involves instilling several drops of the product into the affected ear once or twice daily for a treatment duration of 3 to 5 days. [1] [4] Each instillation is relatively quick (less than 5 minutes) and can be done either at home or in a clinical setting. However, like all ear wax treatments, the ear wax can reaccumulate in the ear after treatment, necessitating further treatment. [1] Cerumenolytics are not recommended in children less than 3 years-old. [1]

Available forms and classification

Cerumenolytics are available as topical preparations intended for installation into the ear. [1] Cerumenolytics can be classified based upon the formulation of their constituents: water based, oil based, or neither. [1]

Available cerumenolytics [1]
ClassificationProduct/preparationActive chemical constituents
Water based
  1. Acetic acid
  2. Cerumenex
  3. Colace
  4. Hydrogen peroxide
  5. Sodium bicarbonate
  6. Sterile saline solution
  1. Aqueous acetic acid
  2. Triethanolamine polypeptide oleate-condensate
  3. Docusate sodium
  4. Hydrogen peroxide solution
  5. Sodium bicarbonate
  6. Water
Oil based
  1. Almond oil
  2. Peanut oil
  3. Earex
  4. Olive oil
  5. Mineral oil/liquid petrolatum
  1. Almond oil
  2. Peanut oil
  3. Peanut oil, almond oil, rectified camphor oil
  4. Olive oil
  5. Liquid petrolatum
Neither
  1. Audax
  2. Debrox
  1. Choline salicylate, glycerine
  2. Carbamide peroxide (urea-hydrogen peroxide)
A member of the U.S. Army cleans the ear of an Iraqi child. Army Spc Taryn Emery cleans the ear of an Iraqi child 061127-M-5585B-016.jpg
A member of the U.S. Army cleans the ear of an Iraqi child.

Contraindications

Cerumenolytics should not be used in ears that in which the ear drum has been perforated or is otherwise nonintact. [1] Cerumenolytics should also be avoided in ears that are actively infected due to the lack of research in this area (i.e. people with otitis externa, a type of ear infection). [1]

Adverse effects

In general, cerumenolytics can cause ear discomfort, transient loss of hearing, dizziness, and local irritation. [1] Local reactions are least frequent with cerumenolytics that lack organic chemicals, such as a saline. [1]

Overdose

Using the cerumenolytic hydrogen peroxide as an example, no adverse effects are expected with overdose of an otic administered preparation. [5] The average middle ear volume is 0.4 mL, which limits otic accumulation in overdose. [6] It is unlikely that an cerumenolytic administered into the ear would cause systemic toxicity in an overdose situation, due to the lack of systemic absorption resulting from minimal volume flow within the inner ear. [7] However, again using hydrogen peroxide as an example, clinically relevant overdoses of cerumenolytics are possible if the drugs are administered by other routes (e.g. by mouth). [8]

Pharmacology

The mechanism of action of cerumenolytics vary by the classification. [1] Water-based cerumenolytics, including water itself, work by hydrating ear wax, fragmenting corneocytes (a type of skin cell) within the ear wax itself. [1] Cerumenolytics with peroxides release oxygen upon contact with the skin, inducing effervescence (bubbling) that mechanically fragments ear wax. [9] Oil-based cerumenolytics provide lubrication to the ear wax, softening the surface without fragmenting the ear wax. The mechanism of action of non-water- and non-oil-based cerumenolytics is unknown. [1] Using carbamide peroxide as an example, the pharmacokinetics of cerumenolytics are not well studied. [10]

Veterinary use

Cerumenolytics are used to treat cerumen impaction in cats and dogs. [11] The removal of cerumen is also an important step in the treatment of otitis in small animals. [12] Veterinary cerumenolytics possess different potencies. Diocytl sodium sulfosuccinate (DOSS), dioctyl calcium sulfosuccinate, and urea or carbamide peroxide are considered to be potent veterinary cerumenolytics. [12]

Related Research Articles

Urea, also called carbamide, is an organic compound with chemical formula CO(NH2)2. This amide has two amino groups joined by a carbonyl functional group. It is thus the simplest amide of carbamic acid.

<span class="mw-page-title-main">Otitis media</span> Inflammation of the middle ear

Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present. The other main type is otitis media with effusion (OME), typically not associated with symptoms, although occasionally a feeling of fullness is described; it is defined as the presence of non-infectious fluid in the middle ear which may persist for weeks or months often after an episode of acute otitis media. Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in a perforated tympanic membrane with discharge from the ear for more than six weeks. It may be a complication of acute otitis media. Pain is rarely present. All three types of otitis media may be associated with hearing loss. If children with hearing loss due to OME do not learn sign language, it may affect their ability to learn.

<span class="mw-page-title-main">Earwax</span> Waxy substance secreted by the ear

Earwax, also known by the medical term cerumen, is a waxy substance secreted in the ear canal of humans and other mammals. Earwax can be many colors, including brown, orange, red, yellowish, and gray. Earwax protects the skin of the human ear canal, assists in cleaning and lubrication, and provides protection against bacteria, fungi, particulate matter, and water.

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<span class="mw-page-title-main">Hydrogen peroxide - urea</span> Chemical compound

Hydrogen peroxide - urea is a white crystalline solid chemical compound composed of equal amounts of hydrogen peroxide and urea. It contains solid and water-free hydrogen peroxide, which offers a higher stability and better controllability than liquid hydrogen peroxide when used as an oxidizing agent. Often called carbamide peroxide in dentistry, it is used as a source of hydrogen peroxide when dissolved in water for bleaching, disinfection and oxidation.

<span class="mw-page-title-main">Topical medication</span> Medication applied to body surfaces

A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes including creams, foams, gels, lotions, and ointments. Many topical medications are epicutaneous, meaning that they are applied directly to the skin. Topical medications may also be inhalational, such as asthma medications, or applied to the surface of tissues other than the skin, such as eye drops applied to the conjunctiva, or ear drops placed in the ear, or medications applied to the surface of a tooth. The word topical derives from Greek τοπικόςtopikos, "of a place".

Tooth whitening or tooth bleaching is the process of lightening the color of human teeth. Whitening is often desirable when teeth become yellowed over time for a number of reasons, and can be achieved by changing the intrinsic or extrinsic color of the tooth enamel. The chemical degradation of the chromogens within or on the tooth is termed as bleaching.

<span class="mw-page-title-main">Ear pain</span> Pain in the ear

Ear pain, also known as earache or otalgia, is pain in the ear. Primary ear pain is pain that originates from the ear. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is felt.

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Ciprofloxacin/dexamethasone (Ciprodex) is an antibiotic/steroid combination medication. It contains the synthetic broad-spectrum antibacterial agent, ciprofloxacin hydrochloride (0.3%), combined with the anti-inflammatory corticosteroid, dexamethasone (0.1%), in a sterile, preserved suspension for otic use.

<span class="mw-page-title-main">Ingrown hair</span> Medical condition

Ingrown hair is a condition where a hair curls back or grows sideways into the skin. The condition is most prevalent among people who have coarse or curly hair. It may or may not be accompanied by an infection of the hair follicle (folliculitis) or "razor bumps", which vary in size. While ingrown hair most commonly appears in areas where the skin is shaved or waxed, it can appear anywhere. Anything that causes the hair to be broken off unevenly with a sharp tip can cause ingrown hairs. Ingrown hairs are also caused because of lack of natural exfoliation in the skin.

<span class="mw-page-title-main">Ear drop</span> Form of medication placed in ears

Ear drops are a form of topical medication for the ears used to treat infection, inflammation, impacted ear wax and local anesthesia. They are commonly used for short-term treatment and can be purchased with or without a prescription. Before using ear drops, refer to the package insert or consult a health professional for the amount of drops to use and the duration of treatment.

<span class="mw-page-title-main">Flumetasone</span> Chemical compound

Flumetasone, also known as flumethasone, is a corticosteroid for topical use. It has anti-inflammatory, antipruritic, and vasoconstrictive properties, and it is approved for human and animal use for a variety of medical conditions.

Otomycosis is a fungal ear infection, a superficial mycotic infection of the outer ear canal caused by micro-organisms called fungi which are related to yeast and mushrooms. It is more common in tropical or warm countries. The infection may be either subacute or acute and is characterized by itching in the ear, malodorous discharge, inflammation, pruritus, scaling, and severe discomfort or ear pain. The mycosis results in inflammation, superficial epithelial exfoliation, masses of debris containing hyphae, suppuration, and pain. Otomycosis can also cause hearing loss.

<span class="mw-page-title-main">Docusate</span> Laxatives/stool softeners

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<span class="mw-page-title-main">Urea-containing cream</span> Dermatologic drug

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<span class="mw-page-title-main">Finafloxacin</span> Chemical compound

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References

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