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)
...1. Summary of Guideline Key Action Statements...
...imary preventionClinicians should expla...
...f cerumen impactionClinicians should diag...
...difying fact...
...lant therapy ( D , R )5...
...mmunocompromised state ( D ,...
...es mellitus ( C , R )5...
...adiation therapy to the head and neck...
...sis, exostoses, non-intact tympanic membrane ( D...
...ntervention if impactedClinicians...
Non-intervention if asymptomaticClinicians should...
...r intervention in special populationsClinicians sh...
...n in hearing aid usersClinicians should...
Recommended interventionsClinicians should treat,...
...ntraindicated intervention (ear candling...
...agentsClinicians may use cerumenolytic agent...
...ationClinicians may use irrigation in the managem...
...ual removalClinicians may use manua...
...essmentClinicians should assess patients at the c...
...l and coordination of careClinicians shoul...
...condary preventionClinicians may educate/co...
Treatment
...reatmen...
...nagement Algorithm* Symptoms of Cerume...
...ions to Help Reduce EarwaxHaving trouble viewin...
...al PreparationsHaving trouble viewing...
...able 4. Proper care of Hearing aid(s...
...red Decision Grid For Patients and Caregivers For...
Patient Information
...ient Informatio...
...requently Asked Questions Is it necess...
Patient Education: Dos and Don’ts of Cerumen (Ea...
Additional Resources
...itional Resourc...
...mpaction Update Podcast (Part 1)...