Cerumen impaction

Diagnosis is made by examining the ear canal. The examination can be done using an otoscope, a handheld speculum, or a binocular microscope.

History and examination

Visualization of cerumen is a simple process and can be carried out in the office in any patient who complains of hearing loss or a feeling of fullness in the ear. Otorrhea in the form of a waxy yellow drainage may be seen in children, although it is less likely to occur in adults. Rarer symptoms are otalgia, tinnitus, cough, and vertigo.

Special attention should be paid to individuals with a cognitive impairment, because they may not be able to complain of symptoms caused by the impaction. Stenosis of the ear canal predisposes to cerumen impaction and can be diagnosed on visualization of the ear canal. Users of hearing aids are also more likely to have impacted cerumen. Cotton-tipped applicator use can push cerumen medially toward the tympanic membrane, often causing cerumen impaction. [Figure caption and citation for the preceding image starts]: Impacted cerumen caused by instrumentation of the ear canal with a cotton-tipped applicatorReprinted with permission from: Hawke M. Ear disease: a clinical guide. Hamilton, London: Decker DTC, 2003 [Citation ends].

Investigations

No specific tests are required because the diagnosis is clinical. An audiogram can be obtained after cerumen impaction has been removed if the patient still complains of hearing impairment.