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Detergents are a viable method for earwax removal. Specifically, bile salts such as cholate and deoxycholate, work well for this function especially when placed in alkaline solution provided by sodium phosphate in the presence of 0.1 M sodium chloride. In vitro studies reveal these agents to quickly penetrate earwax, as visualized by yellowish color of the solution and lack of cohesion of the remaining particulate matter. In clinical studies, after a 5 minute application of the bile acids into ten patients' ears with impacted cerumen, only water irrigation was needed for visibility of the tym- panic membrane. Further studies of cholate and dexoxycholate for ear plugs are warranted. Cerumen serves as a protectant from bacteria and fungus as well as a cleansing and lubricating agent for the external auditory canal. Traditionally dermatology has been at the forefront in the study of earwax (1, 2). Impacted cerumen in the external ear canal not only interferes with the clinician's view of the tymphanic membrane, but occasionally can be associated with hearing loss, vertigo, itching, pain, tinnitus, and increased risk of infection. Ceruminous plugs are a common problem. Indeed, 2.3 million people require man- agement of this problem in the United States. It is estimated that ear syringing is performed 4 million times annually (3). Manual instrumentation with a curette or frequent copious syringe irrigation are the two most common methods of evacuation of cerumen plugs. Of note, these procedures can have complications which include otitis externa, hearing loss, and perforation of the tympanic membrane (4). Cerumen plugs are caused by a constellation of factors including type of earwax, rate of cerumen accumulation, anatomic factors, and presence of excess epidermal slough- ing with desquamated sheets of keratinocytes. Impacted ce- rumen are composed of a combination of desquamated epi- dermal cells lining the ear canal, hair, and secretions of the ceruminal and sebaceous glands located in the outer third of the external ear canal. The chemical composition of earwax consists of long chain fatty acids and alcohols, cholesterol precursors, squalene, and other long-chained hydrocarbons (5). Despite limited publications on point, some detergents have ability to partially dissolve earwax. Most impressive results have been obtained with detergents which have a steroid skeleton structure, such as primary and secondary bile acids. In vitro testing has shown that bile acids, such as cholate and deoxycholate, in the appropriate mixture signifi- cantly disintegrate earwax. An analysis by flash pyroly-

Uses of Bile Salts, Namely Cholate and Deoxycholate for Earwax Removal