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Cerumen Impaction Definition • Cerumen (Ear wax) is a naturally occurring product that provides some protection against common ear pathogens. They are normally extruded naturally from the ear canal. • Excessive built up in the ear canal can lead to potential pathological conditions • Cerumen buildup and blockage commonly occur in people who use Q-tips and cotton swabs to clean their ear canals. • Occur in anyone, but generally asymptomatic Epidemiology • Cerumen impaction is present in approximately: • 10% of children • 5% of normal healthy adults • 57% of older patients in nursing homes • 36% of patients with intellectual disability • Roughly 4% of primary care visits are related to cerumen removal • Most common Otolaryngology procedure performed in a primary care setting. Common Causes • Anatomic deformity or an increased number of hairs in the external auditory canal. • Physical barriers to wax extrusion. Examples: using cotton swabs to clean ear canal, hearing aids, earplug-type hearing protectors. Signs and Symptoms • Fullness in the ear • Pain in the ear • Hearing loss • Tinnitus • Itchiness in the ear • Discharge from the ear • Odor coming from the ear • Dizziness Otoscopy Appearance: Exam of the right external auditory canal shows complete obstruction of the canal with semi-moist cerumen. Anterior canal skin seen shows healthy epithelial lining. Red arrow indicates superior orientation. R6 Otoscopy Appearance: Limited view of the right external auditory canal shows complete obstruction of canal with thick dark cerumen. Note abundant hair lining canal and intertwined within cerumen. Red arrow indicates superior orientation. R7 Otoscopic Appearance https://s-media-cache- https://encrypted- http://bestpractice.bmj.com/best-practice/images/bp/en- ak0.pinimg.com/236x/d6/01/49/d601491df3f5e43432d6 tbn2.gstatic.com/images?q=tbn:ANd9GcSYp5RXuuxZdNLp_ gb/1032-1-hlight-tn_default.jpg 33084aad0f40.jpg le2o3t9Pz0aN0bclTCR9mG4kct8e9rCgoIR Diagnosis • Direct visualization with an otoscope. • Foreign body and swollen canal from otitis externa can block tympanic membrane view and should be ruled out before attempting to remove cerumen. • Audiology exam if suspected hearing loss after removal of cerumen. Treatment • Ceruminolytics alone 3 types of cerumen-softening preparations available: 1) Water-based 2) Oil-based 3) Non-water/Non-oil based • Irrigation of the external auditory canal • Manual removal using a curette, forceps, or suction Pediatric Otolaryngology Referral Guidelines for Cerumen Impaction • Pain develops and persists after cerumen removal. Stop further removal attempts and refer patient to an otolaryngologist. • Vertigo developed during irrigation with water at body temperature • Very swollen ear canal, unusual anatomy, or a history of tympanic membrane perforation, radiation, or surgery. https://www.aafp.org/afp/2007/0515/p15 23.html.

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