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)
Table 1. Summary of Guideline Key Action Statement...
...rimary preventionClinicians should explain...
...of cerumen impactionClinicians should diagnose...
...ying factors...
anticoagulant therapy ( D , R )570
...nocompromised state ( D , R )...
...mellitus ( C , R )570...
...ion therapy to the head and neck ( C , R...
...nal stenosis, exostoses, non-intact tympani...
...for intervention if impactedClinic...
...on-intervention if asymptomaticClinic...
...r intervention in special population...
...ion in hearing aid usersClinicians shou...
...ended interventionsClinicians should treat...
...intervention (ear candling/coning)...
...rumenolytic agentsClinicians may us...
...nClinicians may use irrigation in the mana...
Manual removalClinicians may use manual re...
...comes assessmentClinicians should assess patie...
...erral and coordination of careClinicians shou...
...ry preventionClinicians may educate...
Treatment
...atment...
...re 4. Management Algorithm* Symptoms of...
Table 2. Options to Help Reduce EarwaxHaving trou...
...opical PreparationsHaving trouble viewing table?...
...care of Hearing aid(s) – Tips to clean...
...ble 5. Shared Decision Grid For Patients...
Patient Information
...atient Informat...
...ntly Asked Questions Is it necessa...
...Education: Dos and Don’ts of Cerumen (Ear...
Additional Resources
...dditional Resources
...mpaction Update Podcast (Part 1) Cerumen I...