If the accumulation is more frequent, or if they wish for definative treatment two paradigms are offered. Self-administered two or three drops of mineral oil into each ear canal once weekly. Some patients will use a small bulb syringe to flush their ear with warm water. If indeed they can keep the wax soft and successfully irrigate their ear, remove the wax, not hurt themselves and not induce vertigo, this is a reasonable plan. Prescribe a 60cc bottle of Domeboro otic with instructions to place two drops in each ear once weekly after showering.
Cerumen is produced by eccrine glands in the lateral portion of the external auditory canal.
The accumulation is a balance between the wax production and the outward migration rate of the external auditory canal epithelium. The external auditory canal epithelium is generated on the tympanic membrane and then migrates laterally, out the external auditory canal. The Domeboro stimulates the epithelial migration and therefore facilitates natural removal. This is an effective technique, but requires an individual who is both compulsive and compliant. A word about Q-tips.