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)
...Table 1. Sum...
...preventionClinicians should explain pr...
...s of cerumen impactionClinicians should di...
...difying factors...
...coagulant therapy ( D , R )570...
...promised state ( D , R )570...
...abetes mellitus ( C ,...
...ion therapy to the head and neck ( C ,...
...enosis, exostoses, non-intact tympanic membra...
...intervention if impactedClinicians should t...
...intervention if asymptomaticClinicians should not...
...r intervention in special populationsClinicia...
...ntervention in hearing aid usersClinicians should...
Recommended interventionsClinicians should treat,...
...ntraindicated intervention (ear candling/co...
...entsClinicians may use cerumenolytic agents...
...ationClinicians may use irrigation in the m...
...emovalClinicians may use manual rem...
...tcomes assessmentClinicians should asse...
...oordination of careClinicians should refer...
...preventionClinicians may educate/counsel p...
Treatment
...Treatment...
...ure 4. Management Algorithm* Symptom...
...2. Options to Help Reduce EarwaxHaving...
...PreparationsHaving trouble viewing table...
...ble 4. Proper care of Hearing aid(s) – Tips t...
...d Decision Grid For Patients and Ca...
Patient Information
...Pat...
...ly Asked Questions Is it necessary to treat you...
...tion: Dos and Don’ts of Cerumen (Earwax) Do...
Additional Resources
...Additional Resou...
...n Impaction Update Podcast (Part 1)...