A 29-year-old man presents with ear pain and muffled hearing in his right ear for the past 3 days. He frequently uses cotton swabs to clean his ears and the ear canal is visibly blocked. Which management is most appropriate?

• A. Prescribe antibiotics
• B. Advise the use of ear drops containing sodium bicarbonate to help soften the blockage
• C. Recommend water irrigation at home
• D. Suggest using ear candles

Answer: (B)

The main idea is managing cerumen impaction. When earwax is packed in the canal, especially after frequent cotton swab use, softening the blockage makes it easier to remove safely. Drops that soften cerumen, including those containing sodium bicarbonate, loosen the wax so it can be expelled or gently irrigated later. This noninvasive approach addresses the blockage directly without risk of damaging the ear or introducing infection.

Antibiotics aren’t needed unless there are signs of infection. Home irrigation carries risks if done improperly or if the eardrum is perforated, and ear candles have no proven benefit and can cause harm. So softening the wax first is the most appropriate initial step.