Case history
Case history #1
A 76-year-old man complains of decreased hearing in his right ear for the past two weeks associated with a full feeling in that ear. He noticed the sudden onset of these symptoms on awakening. He has been wearing hearing aids for the past 10 years. He changed the battery in the hearing aid but his symptoms persisted. Physical exam of the right ear shows a cerumen impaction filling the entire ear canal. Only a minimal amount of cerumen is present in the left ear canal.
Case history #2
A 2-year-old girl is brought to the office by her mother because of a one-day history of pain in the left ear. The child attends day care and has had two prior ear infections in the past three months, both of which were treated with antibiotics. Over the past week, she has developed an upper-respiratory infection with symptoms of clear rhinorrhea, cough, but no fever. Her mother has noticed sticky yellow drainage from both ears for the last few weeks and has tried to clean the child's ear with cotton-tipped applicators. Exam shows a fairly cooperative child sitting in her mother's lap. Both ear canals are filled with sticky yellow wax preventing visualization of the tympanic membranes.
Other presentations
Patients with cerumen impaction may present with either local or systemic factors that may make diagnosis and treatment more difficult. Anatomic factors, such as a small ear canal, bony exostoses, or osteomas, may cause difficulty in examining the canal and tympanic membrane. The presence of a perforated tympanic membrane will limit treatment options. The presence of systemic factors, such as diabetes mellitus, anticoagulant therapy, and conditions, such as Down syndrome, may complicate cerumen removal. Concomitant external otitis may also be a complicating factor.
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