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)
...ary of Guideline Key Action Statements (KAS)...
...ry preventionClinicians should explain prope...
...s of cerumen impactionClinicians s...
...fying factors...
...ticoagulant therapy ( D , R...
...romised state ( D , R )570...
...es mellitus ( C , R )570...
...or radiation therapy to the head and neck ( C ,...
...is, exostoses, non-intact tympanic membrane ( D...
Need for intervention if impactedClinicians should...
...ervention if asymptomaticClinicians s...
...intervention in special populationsClinic...
...ervention in hearing aid usersClinician...
...mended interventionsClinicians should treat, or re...
...ntraindicated intervention (ear candling/c...
...menolytic agentsClinicians may use cerumenolyt...
...rigationClinicians may use irrigatio...
...removalClinicians may use manual removal requ...
...assessmentClinicians should assess patients...
...oordination of careClinicians should r...
...eventionClinicians may educate/counsel pati...
Treatment
...atment...
...4. Management Algorithm* Symptoms of Cerumen Im...
...ions to Help Reduce EarwaxHaving trouble v...
...Topical PreparationsHaving trouble viewi...
...4. Proper care of Hearing aid(s) â...
...5. Shared Decision Grid For Patients and...
Patient Information
...tient Informa...
...uently Asked Questions Is it necessary to...
...Education: Dos and Don’ts of Cerumen...
Additional Resources
...tional Resources...
...paction Update Podcast (Part 1) C...