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)

...1. Summary of Guideline Key Action Statements...

...preventionClinicians should explain proper ea...


...cerumen impactionClinicians should...


...difying facto...

...nticoagulant therapy ( D...

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

...mellitus ( C , R )570...

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

...al stenosis, exostoses, non-intact tympanic membr...


...for intervention if impactedClinicians s...


...ervention if asymptomaticClinicians shoul...


...eed for intervention in special populat...


...ention in hearing aid usersClinicians s...


Recommended interventionsClinicians sh...


...ntraindicated intervention (ear candling/coning...


...agentsClinicians may use cerumenolytic agent...


...cians may use irrigation in the manage...


...lClinicians may use manual removal requiring i...


...essmentClinicians should assess pa...


...eferral and coordination of careClinicians should...


...ondary preventionClinicians may educate/co...


Treatment

Treatm...

...igure 4. Management Algorithm* Symptoms of Ceru...


...ons to Help Reduce EarwaxHaving trouble v...


...Topical PreparationsHaving trouble viewi...


...Proper care of Hearing aid(s) – Tips to cleanH...


...ared Decision Grid For Patients and Caregivers For...


Patient Information

...ent Information...

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


...ducation: Dos and Don’ts of Cerumen (Ear...


Additional Resources

...dditional Resources...

...umen Impaction Update Podcast (Par...