Cerumen Impaction

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

Fullness in ear

Conductive hearing loss when accumulation blocks the canal

Made by otoscopic inspection

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

Irrigation

• Should be performed with water at body temperature to avoid a vestibular caloric response

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

• The stream should be directed at the posterior ear canal wall adjacent to the cerumen plug

Use of jet irrigators (designed for cleaning teeth [eg, WaterPik]) 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

• Impaction has not responded to routine measures

• Patient has a history of chronic otitis media or tympanic membrane perforation