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Cerumen Impaction
Aka: Cerumen Impaction, Impacted Ear Wax
- Mechanism
- Apocrine/Sebaceous Gland secretions produce cerumen
- Located in skin lining outer half of canal
- Cerumen acidifies canal with lysozymes
- Prevents Bacterial and fungal growth
- Cerumen is lipid rich and therefore hydrophobic
- Prevents skin penetration and maceration
- 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
- Symptoms
- Otalgia
- Cerumen Impaction is painless, unless:
- Cerumen touches Tympanic Membrane
- Cerumen injures external canal
- 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
- Ear fullness sensation
- Ear Pruritus
- Tinnitus
- 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
- Management
- 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
- Whatley (2003) Arch Pediatr Adolesc Med 157:1177 [PubMed]
- Roland (2004) Arch Otolaryngol Head Neck Surg 130 [PubMed]
- 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)
- References
- Malaty (2018) Am Fam Physician 98(8): 525-9 [PubMed]
- Singer (2000) Ann Emerg Med 36:228-32 [PubMed]