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Cerumen impaction
Background
Overview
Definition
Cerumen impaction refers to symptomatic accumulation of cerumen in the external ear.
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Pathophysiology
The accumulation of a mixture of ceruminous and sebaceous gland secretions mixed with desquamated epithelium results in cerumen impaction. Overproduction of ear wax and narrowing of the ear canal by massess or bony growths may predisopse to impaction.
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Disease course
Cerumen impaction is usually asymptomatic but can cause ear discomfort, hearing loss, tinnitus, dizziness, chronic cough, and otitis externa.
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Prognosis and risk of recurrence
Cerumen impaction is not associated with increased mortality.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of cerumen impaction are prepared by our editorial team based on guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2017).
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Screening and diagnosis
Diagnostic investigations
Clinical history: as per AAO-HNSF 2017 guidelines, assess patients with cerumen impaction by history and/or physical examination for factors that modify management, such as ≥ 1 of the following:
anticoagulant therapy
immunocompromised state
diabetes mellitus
prior radiation therapy to the head and neck
ear canal stenosis or exostoses
nonintact tympanic membrane.
B
Medical management
Indications for treatment
As per AAO-HNSF 2017 guidelines:
Avoid offering routine treatment of cerumen in asymptomatic patients with adequately examinable ears.
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Offer cerumenolytic agents, irrigation, and/or manual removal requiring instrumentation in patients with cerumen impaction.
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Cerumenolytic agents
Assessment of treatment response
Therapeutic procedures
Ear candling/coning: as per AAO-HNSF 2017 guidelines, advise against ear candling/coning for the treatment or prevention of cerumen impaction.
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Irrigation
Manual removal
Specific circumstances
Patients with hearing aids: as per AAO-HNSF 2017 guidelines, perform otoscopy to detect the presence of cerumen in patients with hearing aids.
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Patients who may not express symptoms
Preventative measures
Primary prevention: as per AAO-HNSF 2017 guidelines, explain proper ear hygiene to prevent cerumen impaction in patients who display an accumulation of cerumen.
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Secondary prevention