Complications
Occasionally, patients with a cerumen impaction will also present with otalgia and foul-smelling drainage due to a secondary infection. This is usually associated with water entering the ear, causing maceration of the canal skin and consequent infection. Physical findings include foul-smelling drainage, erythema, and sometimes oedema of the ear-canal skin, in conjunction with a cerumen impaction. Treatment consists of removing the impaction, along with any pus and debris, and prescribing antibiotic or antiseptic ear drops. Systemic antibiotics are used when the initial treatment is unsuccessful, in patients with diabetes or immunocompromise, or if there is necrotising or malignant external otitis.
Immunocompromised individuals, including those with diabetes, may develop osteitis of the ear canal and temporal bone associated with water irrigation of the ear canal.[14][15] Clinicians who utilise water irrigation in patients with diabetes and cerumen impaction should minimise trauma, consider use of an acidifying agent to lower the pH of the ear canal, and provide close follow-up.[18]
Trauma to the ear canal and tympanic membrane arises most frequently with the use of high-pressure irrigation systems. The injury may consist of laceration and bleeding of the ear canal, tympanic-membrane perforation, and, on rare occasions, permanent hearing loss and imbalance.
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