II. Indications

III. Precautions

  1. Perform under direct visualization if possible
  2. Always keep Tympanic Membrane distance in mind

IV. Curettes

  1. Jobson-Horne loop (wire probe with "O" at end)
  2. Buck's #1 cerumen spoon
  3. Plastic loops/spoons: unlikely to damage canal

V. Manual Removal Technique (effective in 97% children)

  1. Steady hand rests against child's head ALWAYS
    1. Start where cerumen already separated from wall
  2. Light touch, work around periphery of Occlusion
  3. Attempt to remove cerumen in one piece

VI. Ceruminolytics (if manual removal fails)

  1. Do not use if Tympanostomy Tubes OR TM Perforation
  2. Medication options
    1. See Cerumen Softening Agents
    2. Saline is as effective as other cerumenolytics
  3. Technique
    1. A few drops left in ear canal for 15-30 minutes
    2. Then remove with curette OR warm water lavage

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