The efficacy of ceruminolytics: everything old is new again.

Impacted cerumen frequently poses a problem to both patients and physicians. Over the years, many topical ceruminolytics have been advocated, many of which are currently used with no scientific proof of their effectiveness. The effects of a variety of ceruminolytics were tested in vitro on standard spheres of normal human cerumen. The only truly effective ceruminolytics had an aqueous base, and the most effective ceruminolytic was a 10% solution of sodium bicarbonate. In contrast, those ceruminolytics which had an organic base, including most of the commonly available commercial preparations, had little ceruminolytic effect. When we consider that Joseph Toynbee recommended the use of sodium bicarbonate ear drops as a ceruminolytic in 1860, then surely, when looking for the ideal ceruminolytic, "everything old is new again".