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Guideline for Cerumen Impaction Management

Otolaryngol Head Neck Surg; 2017 Jan 3; Schwartz, et al

The American Academy of Otolaryngology—Head and Neck Surgery Foundation has issued an update to its 2008 cerumen impaction clinical practice guideline, which provides evidence-based recommendations on managing cerumen impaction. The guidelines include:

  • Clinicians should diagnose cerumen impaction when an accumulation of cerumen, as seen on otoscopy, is associated with symptoms, prevents needed assessment of the ear, or both.
  • Clinicians should not routinely treat cerumen in patients who are asymptomatic and whose ears can be adequately examined.
  • Clinicians should perform otoscopy to detect the presence of cerumen in patients with hearing aids during a health care encounter.
  • Clinicians should treat, or refer to a clinician who can treat, the patient with cerumen impaction with an appropriate intervention, which may include ≥1 of the following: cerumenolytic agents, irrigation, or manual removal requiring instrumentation.
  • Clinicians should recommend against ear candling for treating or preventing cerumen impaction.
  • Clinicians should assess patients at the conclusion of in-office treatment of cerumen impaction and document the resolution of impaction.
  • Finally, if initial management is unsuccessful, clinicians should refer patients with persistent cerumen impaction to clinicians who have specialized equipment and training to clean and evaluate ear canals and tympanic membranes.

Citation:

Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical practice guideline (update): Earwax (cerumen impaction). Otolaryngol Head Neck Surg. 2017;156(1):S1-S29. doi:10.1177/0194599816671491.

Commentary:

Approximately 4% of primary care patients will present with cerumen impaction each year, making cerumen removal the most common ENT procedure in primary care. It is more common in the elderly and in those with developmental disabilities. Common symptoms include a feeling of fullness, as well as hearing loss. Note, the guidelines emphasize that a diagnosis of cerumen impaction should only be made and addressed if it is causing a functional problem. When cerumen impaction is found, there is no evidence to suggest that any of the 3 methods for removing wax—cerumenolytic agents, irrigation, or manual removal requiring instrumentation—is better than the other. Often a combination of approaches can be helpful. —Neil Skolnik, MD