Cerumen Impaction

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

  • 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