Cerumen Impaction

Last updated March 17, 2022

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)

...T...

...rimary preventionClinicians should explain p...


...osis of cerumen impactionClinicians should diagno...


...difying fact...

...coagulant therapy ( D , R )5...

...unocompromised state ( D , R )570...

...mellitus ( C , R )570

...radiation therapy to the head and neck ( C...

...nal stenosis, exostoses, non-intact tympani...


...or intervention if impactedClinicians sho...


Non-intervention if asymptomaticClinicians sh...


...vention in special populationsClinicians...


...in hearing aid usersClinicians should p...


...rventionsClinicians should treat, or refer to a cl...


...indicated intervention (ear candling/coning)Clin...


...rumenolytic agentsClinicians may u...


...cians may use irrigation in the mana...


...ual removalClinicians may use manual r...


...smentClinicians should assess pati...


...al and coordination of careClinicia...


...eventionClinicians may educate/counsel patie...


Treatment

...Treatment...

...e 4. Management Algorithm * Symptoms of Cerume...


...ions to Help Reduce EarwaxSecondary Prevent...


...ble 3. Topical Preparations...


...oper care of Hearing aid(s) – Tips to clean...


...5. Shared Decision Grid For Patients and...


Patient Information

...Patient Information...

...quently Asked Questions Is it necessary to treat...


...ucation: Dos and Don’ts of Cerumen (E...


Additional Resources

...A...

...umen Impaction Update Podcast (Part 1)...