Otolaryngology Book

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Manual Cerumen Removal

Aka: Manual Cerumen Removal, Ear Curette, Cerumen Removal By Instrumentation
  1. Indications
    1. Cerumen Impaction
  2. Precautions
    1. Perform under direct visualization if possible
    2. Always keep Tympanic Membrane distance in mind
    3. Exercise caution in groups at risk for complications
      1. Coagulopathy
      2. External otitis (Diabetes Mellitus, immunocompromised, Ear Canal Dermatitis)
  3. Preparations: 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
  4. Management: 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
  5. Management: 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
  6. Complications
    1. Ear canal bleeding risk factors
      1. Anticoagulant or antiplatelet medication use
      2. Thrombocytopenia
      3. Hemophilia
      4. Other Coagulopathy (e.g. liver failure)
    2. Otitis Externa (including Malignant Otitis Externa) risk factors
      1. Diabetes Mellitus
      2. Ear Canal Dermatitis (e.g. Eczema, Seborrheic Dermatitis, ectodermal dysplasia)
      3. Prior head and neck radiation (ear canal dryness results in greater Trauma with wax removal)
      4. Anatomic abnormalities (e.g. auditory canal stenosis, osteomas)
  7. References
    1. Malaty (2018) Am Fam Physician 98(8): 525-9 [PubMed]

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