II. Indications
III. Precautions
- Perform under direct visualization if possible
- Always keep Tympanic Membrane distance in mind
-
Exercise caution in groups at risk for complications
- Coagulopathy
- External otitis (Diabetes Mellitus, Immunocompromised, Ear Canal Dermatitis)
IV. Preparations: Curettes
- Jobson-Horne loop (wire probe with "O" at end)
- Buck's #1 cerumen spoon
- Plastic loops/spoons: unlikely to damage canal
V. Management: Manual Removal Technique (effective in 97% children)
- Steady hand rests against child's head ALWAYS
- Start where cerumen already separated from wall
- Light touch, work around periphery of Occlusion
- Attempt to remove cerumen in one piece
VI. Management: Ceruminolytics (if manual removal fails)
- Do not use if Tympanostomy Tubes OR TM Perforation
- Medication options
- See Cerumen Softening Agents
- Saline is as effective as other Cerumenolytics
- Technique
- A few drops left in ear canal for 15-30 minutes
- Then remove with curette OR warm water lavage
VII. Complications
- Ear canal bleeding risk factors
- Anticoagulant or antiplatelet medication use
- Thrombocytopenia
- Hemophilia
- Other Coagulopathy (e.g. liver failure)
-
Otitis Externa (including Malignant Otitis Externa) risk factors
- Diabetes Mellitus
- Ear Canal Dermatitis (e.g. Eczema, Seborrheic Dermatitis, ectodermal dysplasia)
- Prior head and neck radiation (ear canal dryness results in greater Trauma with wax removal)
- Anatomic abnormalities (e.g. auditory canal stenosis, osteomas)