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)
...mary of Guideline Key Action Statements (KAS)...
...preventionClinicians should explain p...
...nosis of cerumen impactionClinicians...
...difying factors
...icoagulant therapy ( D , R )57...
...compromised state ( D , R )570...
...abetes mellitus ( C , R )5...
...iation therapy to the head and neck ( C ,...
...stenosis, exostoses, non-intact tympanic mem...
...ed for intervention if impactedClinicia...
...on if asymptomaticClinicians should not routine...
...ntervention in special populationsClinicians shoul...
...n in hearing aid usersClinicians should perfo...
...ended interventionsClinicians should treat, or...
...ntraindicated intervention (ear candling/c...
...umenolytic agentsClinicians may use cerumenolytic...
...inicians may use irrigation in the management of c...
...Clinicians may use manual removal requ...
...smentClinicians should assess patients at...
...ordination of careClinicians should refer pati...
...ry preventionClinicians may educate/counsel pat...
Treatment
...atment...
.... Management Algorithm* Symptoms of Ceru...
...e 2. Options to Help Reduce EarwaxHaving troubl...
...ble 3. Topical PreparationsHaving troub...
...e 4. Proper care of Hearing aid(s) – Tips t...
.... Shared Decision Grid For Patients and C...
Patient Information
...nt Information...
...uently Asked Questions Is it necessary to...
Patient Education: Dos and Don’ts of Cerumen (Ea...
Additional Resources
Additional Resourc...
...ction Update Podcast (Part 1) Cerumen...