Cerumen Impaction

Publication Date: January 1, 2017

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. Summ...

...entionClinicians should explain pr...


...sis of cerumen impactionClinicians shou...


...difying fact...

...agulant therapy ( D , R...

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

diabetes mellitus ( C , R )5...

...ior radiation therapy to the head and...

...osis, exostoses, non-intact tympanic membra...


...tervention if impactedClinicians sho...


...intervention if asymptomaticClinicians should not...


Need for intervention in special populationsC...


...rvention in hearing aid usersClinicians should per...


Recommended interventionsClinicians sh...


...dicated intervention (ear candling/c...


...tic agentsClinicians may use cerumenolytic agents...


...Clinicians may use irrigation in the management of...


...emovalClinicians may use manual removal...


...entClinicians should assess patients...


...eferral and coordination of careClinicians shou...


...reventionClinicians may educate/coun...


Treatment

...Treat...

...ment Algorithm * Symptoms of Cerumen Impact...


...2. Options to Help Reduce EarwaxSecondary Preve...


...3. Topical Preparations...


...able 4. Proper care of Hearing aid(s) ...


...able 5. Shared Decision Grid For Patien...


Patient Information

...Patie...

Frequently Asked Questions Is it necessary to...


...t Education: Dos and Don’ts of C...


Additional Resources

...Additional Resources...

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