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Doc,

Colace is a brand name of docusate sodium, which is the salt of a long chain
fatty acid, more commonly known chemically as a soap. It comes as pills or
as a liquid. It is very cheap. The liquid form tastes bitter like soap,
which is why I only use it as a laxative if the child can swallow pills or
has a g-tube.

The liquid form is used for ears. It is viscous enough to stay in place. It
softens the wax (or feces) by adding moisture. It lubricates. Its primary
effect may be to "dissolve" the adhesion of dry wax to skin so that pulling
out the wax does not tear off fragile skin, like pulling off a scab.

The other commonly used compounds for softening wax are Ceruminex
(Triethanolamine) which is an alcohol like compound, or hydrogen peroxide at
half strength. Water alone works reasonably well and I have seen a Water-Pik
(tooth cleaning device) used to soften and irrigate wax from the ear canal.

I rarely use any of these methods.


Kevin Powell MD PhD FAAP
Pediatric hospitalist
Saint Louis, MO






-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Doc Holiday
Sent: Thursday, March 23, 2017 8:51 AM
To: [log in to unmask]
Subject: Re: Cerumen impaction

A couple more questions... (Sorry - I am a slow thinker):


First, [before reading this, please make sure you are seated in a seat with
arm-rests so that you don't fall to the floor, stunned by my ignorance], I
have just googled Colace quickly... Told you - I did not know it... The
entries are for a laxative... Are we talking about faecal impaction in the
ear?... Seriously - I now really need to know precisely what, how and, for
Pete's sake, why, this is used for wax impaction...


Second, quick survey... Let's see how many of you respond...

Of your past cases of a child with, say viral URTI, with ears that have
cerumen obstructing your view and in whom you have decided it was worth the
trouble to remove the cerumen and in whom you have then succeeded in
removing it... Take 100 such cases... In how many did you then prescribe
antibiotics and in how many did you not? What I am trying to find out is
whether in a case who is unwell enough for you to consider it's worth having
a look at the TMs, but it's a hassle, once you have looked, do you often
enough decide NOT to give antibiotics to make it worthwhile to keep
looking...





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