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Key Features

  • Cerumen is a protective secretion produced by the outer portion of the ear canal

  • In most individuals, the ear canal is self-cleansing

  • Recommended hygiene consists of cleaning the external opening with a washcloth over the index finger without entering the canal itself

  • In most cases, cerumen impaction is self-induced through ill-advised attempts at cleaning the ear

Clinical Findings

  • Fullness in ear

  • Conductive hearing loss when accumulation blocks the canal

Diagnosis

  • Made by otoscopic inspection

Treatment

  • May be relieved with detergent ear drops (eg, 3% hydrogen peroxide; 6.5% carbamide peroxide), mechanical removal, suction, or irrigation

  • Irrigation is performed with water at body temperature to avoid a vestibular caloric response. The stream should be directed at the posterior ear canal wall adjacent to the cerumen plug

  • Irrigation should be performed only when the tympanic membrane is known to be intact

  • Use of jet irrigators designed for cleaning teeth (eg, WaterPik) for wax removal should be avoided because they may result in tympanic membrane perforations

  • After irrigation, the ear canal should be thoroughly dried (eg, by instilling isopropyl alcohol or using a hair blow-dryer on low-power setting) to reduce the likelihood of inducing external otitis

  • Specialty referral for cleaning under microscopic guidance is indicated when the impaction is recurrent, has not responded to routine measures, or if the patient has a history of chronic otitis media or tympanic membrane perforation

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