Cerumen Impaction Removal
Removal of cerumen (wax) from the ear is a significant amount of the workload of an otolaryngologist and is, therefore, an essential skill to master.1 However, general practitioners, emergency department staff, nurses, audiologists, audiological physicians, and alternative medicine practitioners may all be confronted with the scenario of excess ear wax that causes difficulty in examination, hearing loss, or discomfort.2
In an evaluation of 279 children with acute otitis media with effusion, ear wax needed to be removed to visualize the tympanic membrane in 29% of consultations.3 Many options are available to attempt to clear ear wax; only methods that are used in routine otolaryngological practice, but are still applicable to practitioners of other disciplines, are discussed in this article.
Cerumen in the external ear canal is a physiological finding. Indications to address the cerumen include the following4:
Difficulty in examining the full tympanic membrane
Wax occlusion of the external ear canal
As part of the workup for conductive hearing loss
Prior to taking the impression for hearing aid fitting
Suspected external ear canal or middle ear cholesteatoma
Suspected external ear canal pathology such as squamous cell carcinoma or eczema
As part of the follow-up to canal wall down mastoidectomy
As part of grommet insertion or middle ear surgery (preoperatively or perioperatively)
Specific contraindications exist for specific procedures. Individual assessment dictates which technique to use.
Contraindications to irrigation include the presence or history of a perforated tympanic membrane, previous pain on irrigation, or previous surgery to the middle ear.
A relative contraindication to probing is the inability to visualize the ear canal.
A relative contraindication to microsuction is severe previous exacerbation of tinnitus.
Exceptional caution has to be used when clearing cerumen in patients who have undergone mastoidectomy, during which sensitive anatomical structures like the facial nerve and semicircular canals were exposed.