II. Mechanism
- Apocrine/Sebaceous Gland secretions produce cerumen
- Cerumen is spontaneously cleared from the canal by jaw motion and other mechanisms
- Impaction occurs from attempts to remove cerumen
- Exacerbated by swimming and showering
- Water moistens and expands cerumen
III. Symptoms
-
Otalgia
- Cerumen Impaction is painless, unless:
- Cerumen touches Tympanic Membrane
- Cerumen injures external canal
- Cerumen Impaction is painless, unless:
-
Hearing Loss
- Requires completely obscured canal
- Even a tiny hole of patency will maintain Hearing
-
Vertigo or disequilibrium
- Associated with cerumen touching Tympanic Membrane
- Other symptoms
IV. Indications: Removal of cerumen
- Hearing Loss
- Otalgia
- Cerumen obscures exam
- Diagnosis requires 75% of Tympanic Membrane viewed
- Ear evaluation requires cerumen removal in 33% cases
- Children under age 1 year more often require removal
- Cerumen removal required for auditory or vestibular testing
- Cerumen does not affect Tympanic Temperature reading
V. Management: Cerumen Removal
-
Cerumen Softening Agents
- See Cerumen Softening Agents
- Debrox drops
- Acetic acid 1.5% with water
- Hydrogen Peroxide or Benzalkonium chloride
- Office cerumen removal
- Manual Cerumen Removal
- Warm Water Ear Lavage
- Cerumen removal by Ear Canal Suction
- Cerumen softening before irrigation not effective
- Agents that have shown no benefit compared with saline
- Triethanolamine polypeptide (Cerumenex) drops
- DocusateSodium 1 ml
- Carbamide Peroxide
- References
- Agents that have shown no benefit compared with saline
VI. Management: Ear Canal Bleeding after Cerumen Removal
- Visualize ear canal for Trauma (exclude Tympanic Membrane or middle ear Trauma)
- Local pressure may be applied with a cotton-tipped applicator
- Persistent minor bleeding (consult ENT for significant bleeding from ear canal Trauma)
- Place ear wick in canal followed by 1-2 drops of nasal Decongestant (or Tranexamic Acid)
- Patient should place 1-2 drops of Oxymetazoline (adult) every 12 hours or neosynephrine (child) every 6 hours
- Remove wick in 24 hours and return for recurrent bleeding
- May place gauze inside a concave eye patch (with elastic band) over the ear
VII. Prevention
- See Cerumen Softening Agents for home preventive protocol for recurrent impaction
- Do not use cotton swabs in the ear canal
- Cotton swabs only further impact cerumen that is present
- Avoid ear candling (ineffective and risk of adverse effects)
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Finding (T033) |
| ICD9 | 380.4 |
| ICD10 | H61.2 |
| SnomedCT | 155214004, 194230008, 18070006 |
| LNC | LA15481-7 |
| Italian | Tappo di cerume |
| Dutch | cerumenprop, oorsmeerprop, cerumen; impactie, impactie; cerumen, Cerumenprop, cerumen samengeperst |
| French | Cérumen impacté, Cérumen enclavé, Inclusion de cérumen |
| Portuguese | Rolhão de cerúmen, Retenção de cerume |
| Spanish | Cera impactada, Cerumen impactado, cerumen impactado (trastorno), cerumen impactado, Impactación de cerumen |
| Japanese | 耳垢栓塞, ｼﾞｺｳｾﾝｿｸ |
| English | cerumen impaction, impacted earwax, cerumen impaction (diagnosis), cerumen impactions, impacted wax, impacted cerumen, cerumen impacted, impact cerumen, Cerumen impaction, Impacted cerumen (wax in ear), Impacted wax (disorder), Impacted wax, Impacted cerumen (disorder), cerumen; impaction, impaction; cerumen, Impacted cerumen |
| German | Zeruminalpfropf, Ohrpfropf |
| Czech | Mazová zátka, Cerumen obturans, Zaklíněné cerumen |
| Korean | 귀지떡 |
| Hungarian | Impactált cerumen, cerumen impactio, Impactált fülzsír |
