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)
...mmary of Guideline Key Action Stat...
...ry preventionClinicians should explain pr...
...cerumen impactionClinicians should diagnose cerume...
...fying factors...
...agulant therapy ( D , R )570...
...promised state ( D , R )570...
...abetes mellitus ( C ,...
...therapy to the head and neck ( C , R )570...
...nosis, exostoses, non-intact tympanic...
...ention if impactedClinicians should treat, or r...
...-intervention if asymptomaticClinicians sh...
...intervention in special populationsClinicia...
...rvention in hearing aid usersClinicians should p...
...d interventionsClinicians should treat, or refe...
...ted intervention (ear candling/coning)Clinician...
...entsClinicians may use cerumenolytic agents (inclu...
...inicians may use irrigation in the management of...
...linicians may use manual removal requir...
...entClinicians should assess patients at t...
...coordination of careClinicians should refer pa...
...preventionClinicians may educate/counsel...
Treatment
Treatme...
...nagement Algorithm* Symptoms of Cerumen Impac...
...Options to Help Reduce EarwaxHaving tro...
...pical PreparationsHaving trouble viewing ta...
...er care of Hearing aid(s) – Tips to cleanHaving...
Table 5. Shared Decision Grid For Patients a...
Patient Information
...atient Inform...
...y Asked Questions Is it necessary to treat y...
...ducation: Dos and Don’ts of Cerumen (Earwax...
Additional Resources
...onal Resources...
...action Update Podcast (Part 1) Cerumen Impa...