Docusate sodium given 15 minutes before irrigation is most effective for facilitating cerumen removal during a single office visit. (Grade of recommendation: B, based on head-to-head trials that lacked irrigationonly arms.) Treatment with 5% urea hydrogen peroxide in glycerol is most effective for facilitating cerumen removal between office visits, reducing the amount of irrigation needed. (Grade of recommendation: B-, based on lack of rigorous randomization, lack of definition of cerumen impaction, and only one placebo-controlled trial.) No trials recommending one strategy over another exist
