Ceruminolytics

There is a great need for a better ceruminolytic. A ceruminolytic should disrupt the structural
integrity of the keratin sheets and thereby soften, loosen, liquefy, and/or dissolve cerumen
and perhaps even float it out. The integrity of the cell membrane is thus reduced, which
allows water to pass into the corneocytes along an osmotic gradient. The hydration causes the
corneocytes to swell and fragment. The aim of ceruminolysis is to disrupt the keratinocytes
on the outside of the plug, as well as those that are located between the plug and the ear
canal. Once this is accomplished, the cerumen can be removed by curettage, aspiration, or
microdebridement.

The two types of available ceruminolytics are aqueous and organic. Among the aqueous
solutions are ordinary water, 10% sodium bicarbonate, 3% hydrogen peroxide, 2% acetic
acid, and a combination of 0.5% aluminum acetate and 0.03% benzethonium chloride.
Overall, aqueous solutions do a fairly good job of expanding and loosening or dissolving
cerumen plugs. Oil-based organic solutions include olive oil, glycerin, propylene glycol,
spirit of turpentine, and liquid paraffin. They basically do nothing but lubricate. They do not
dissolve or expand corneocytes, and as a result they have no effect on the structural integrity
of keratin squames.

Some ceruminolytics--particularly the organic solutions--can cause sensitivity reactions, such

as contact dermatitis. Also, a failure to remove cerumen completely can result in a fungal
superinfection. Another possible complication is ototoxicity, which can occur if a perforation
is present. In many patients, a cerumen plug blocks the view of the tympanic membrane, so
we cannot know for certain whether a perforation is present. Nevertheless, we can make an
educated guess with a reasonable degree of reliability.

The speed of a particular ceruminolytic's action depends on the removal technique you will
use, the amount of cerumen, the hardness of the cerumen (i.e., its keratin content), and the
temperature of the ceruminolytic.