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I am a long time adult Ed doc who sees lots of pediatrics.  I have used colace in the ear for cerumen impactions since the 80s.  I used to get a capsule and punture a hole with an 18 gauge and squirt it in.  Then irrigate.  This is mostly for adult patients whose chief complaint is ear discomfort or loss of hearing.  I do not use it for pediatrics.  I do not muck around trying to clean a pediatric patients ear.  I apologize to the gods of pediatric otology.  I find if i irrigate an ear it causes more goop than would allow me to see anything.  I find a curette in our patient population to be impossible without causing bleeding and major distress.  I would be inclined to give Ketamine first if i really needed to unless i happened to have an especially cooperative child and intelligent parent.

Don
> On Mar 23, 2017, at 6:51 AM, Doc Holiday <[log in to unmask]> wrote:
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> A couple more questions... (Sorry - I am a slow thinker):
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> 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...
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> Second, quick survey... Let's see how many of you respond...
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> 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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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html