Cerumen (ear wax) is a naturally occurring substance that cleans, protects, and lubricates the external auditory canal.
Impaction is diagnosed when an accumulation of cerumen results in symptoms, such as hearing loss, or when it prevents adequate assessment of the ear canal or tympanic membrane.
Intervention may include manual removal, irrigation, or use of cerumenolytic agents, or a combination of these modalities.
After treatment, the clinician should re-examine the patient's ear and document the resolution of the cerumen impaction, and also inspect the previously occluded tympanic membrane.
Young children, older patients, hearing aid users, individuals with a cognitive impairment, and those in nursing homes are at higher risk for cerumen impactions.
Cerumen is a mixture of secretions and sloughed epithelial cells. A cerumen impaction is an accumulation of cerumen that causes symptoms, such as hearing loss, fullness, otorrhea, tinnitus, dizziness, or other symptoms, and/or prevents a required assessment of the ear canal, tympanic membrane, or audiovestibular system.
History and exam
Key diagnostic factors
- visualization of cerumen
- hearing loss
- fullness in the ear
Other diagnostic factors
- age >50 or <5 years
- male sex
- stenotic ear canal
- Down syndrome
- cotton-tipped applicator use
- hearing aid use
- living in a nursing home
Investigations to consider
- External otitis
- Keratosis obturans
- Polyp of ear canal
- Clinical practice guideline (update): earwax (cerumen impaction)
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