Cerumen Impaction
Key Points
Key Points
- Cerumen forms when glandular secretions from the outer two-thirds of the ear canal mix with exfoliated squamous epithelium.
- Normally, cerumen is eliminated or expelled by a self-cleaning mechanism, which causes it to migrate out of the ear canal assisted by jaw movement.
- Blockage of the ear canal from cerumen can lead to a host of symptoms including: hearing loss, tinnitus, fullness, itching, otalgia, discharge, odor, or cough.
- In addition, cerumen impaction can prevent diagnostic assessment by preventing complete examination of the external auditory canal and/or ear drum (tympanic membrane) or by interfering with diagnostic assessment (i.e. audiometry, tympanometry).
- Asymptomatic cerumen does not require active management.
- This guideline does not apply to patients with cerumen impaction associated with the following conditions: dermatologic diseases of the ear canal, recurrent otitis externa, keratosis obturans, prior radiation therapy affecting the ear, previous tympanoplasty/myringoplasty or canal wall down mastoidectomy or other surgery affecting the ear canal.
Figure 1. Cerumen
Figure 2. Otoscopic view of impacted cerumen that completely fills the ear canal
Figure 3. Otoscopic view of impacted cerumen, mixed with hair, completely obstructing the ear canal
Table 1. Summary of Guideline Key Action Statements (KAS)
...ummary of Guideline Key Action Statements (KA...
...ventionClinicians should explain pr...
Diagnosis of cerumen impactionClinicians shou...
...ying factors...
...ticoagulant therapy ( D , R )...
...omised state ( D , R )570...
...ellitus ( C , R )570...
...n therapy to the head and neck ( C , R )570...
...canal stenosis, exostoses, non-inta...
...ntervention if impactedClinicians should treat, o...
Non-intervention if asymptomaticCl...
...tervention in special populationsClinicians shoul...
...n hearing aid usersClinicians should perform otos...
...commended interventionsClinicians sho...
...cated intervention (ear candling/coning)Clin...
...agentsClinicians may use cerumenolytic agents...
...rigationClinicians may use irrigati...
Manual removalClinicians may use manual removal...
...utcomes assessmentClinicians should assess patien...
...nd coordination of careClinicians should refe...
...tionClinicians may educate/counsel patients wi...
Treatment
...atment...
...ement Algorithm* Symptoms of Cerum...
...Options to Help Reduce EarwaxHaving t...
...cal PreparationsHaving trouble viewi...
Table 4. Proper care of Hearing aid...
...hared Decision Grid For Patients and Caregi...
Patient Information
...ent Information...
...ked Questions Is it necessary to...
...ent Education: Dos and Don’ts of Cerumen (Ear...
Additional Resources
...onal Resources
...Impaction Update Podcast (Part 1) Cerumen Impa...