Cerumen impaction
- Overview
- Theory
- Diagnosis
- Management
- Follow up
- Resources
Treatment algorithm
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer
all patients
aural irrigation
Performed mainly in primary care. The choice of treatment depends on the skill, experience, and comfort level of the clinician, as well as the patient's history.
Should be avoided in patients with a history of tympanic-membrane perforation; ear-canal stenosis; prior ear surgery, including canal-wall-down mastoidectomy; an uncooperative child; external otitis; or when previous treatment methods are unsuccessful.
This method appears to be safe if low pressures are used and the stream of water is directed toward the ear canal rather than toward the tympanic membrane.
cerumenolytic agent
Treatment recommended for SOME patients in selected patient group
Applying the cerumenolytic agent 15 to 20 minutes prior to syringing the ear increases the success rate of cerumen removal to 97%.[12]Roland PS, Eaton DA, Gross RD, et al. Randomized, placebo-controlled evaluation of Cerumenex and murine earwax removal products. Arch Otolaryngol Head Neck Surg. 2004 Oct;130(10):1175-7. https://archotol.ama-assn.org/cgi/content/full/130/10/1175 http://www.ncbi.nlm.nih.gov/pubmed/15492164?tool=bestpractice.com
Primary options
acetic acid otic: (2%) 1 dropperful into the affected ear(s)
More acetic acid oticApplied by the clinician to soften wax prior to manual removal or irrigation. Patient may be instructed to use daily for a few days prior to another attempt at manual removal or irrigation.
OR
docusate sodium otic: 1 dropperful into the affected ear(s)
More docusate sodium oticApplied by the clinician to soften wax prior to manual removal or irrigation.
OR
hydrogen peroxide otic: 1 dropperful into the affected ear(s)
More hydrogen peroxide oticApplied by the clinician to soften wax prior to manual removal or irrigation. Children may be frightened by the bubbly sound.
OR
normal saline: 1 dropperful into the affected ear(s)
More normal salineApplied by the clinician to soften wax prior to manual removal or irrigation. Patient may be instructed to use daily for a few days prior to another attempt at manual removal or irrigation.
OR
olive oil otic: 1 dropperful into the affected ear(s)
More olive oil oticApplied by the clinician to soften wax prior to manual removal or irrigation. Patient may be instructed to use daily for a few days prior to another attempt at manual removal or irrigation.
OR
mineral oil otic: 1 dropperful into the affected ear(s)
More mineral oil oticApplied by the clinician to soften wax prior to manual removal or irrigation. Patient may be instructed to use daily for a few days prior to another attempt at manual removal or irrigation.
OR
carbamide peroxide otic: (6.5%) 5-10 drops into the affected ear(s) twice daily
More carbamide peroxide oticIt is most effective if used by the patient in conjunction with warm water irrigation using a soft ear syringe (baby bulb syringe).
manual removal
Performed mainly by ENT specialists. The choice of treatment depends on the skill, experience, and comfort level of the clinician, as well as the patient's history.
More suitable than irrigation in patients with a history of tympanic-membrane perforation; ear-canal stenosis; prior ear surgery, including canal-wall-down mastoidectomy; an uncooperative child; external otitis; or when previous treatment methods are unsuccessful.
Ear curettes, right-angle probes, forceps, microsuction devices, or a combination of instruments can be used, depending on the location and consistency of the impacted cerumen. The binocular microscope provides excellent light, binocular vision with depth perception, and magnification.
cerumenolytic agent
Treatment recommended for SOME patients in selected patient group
Anecdotal evidence indicates that use of a variety of cerumenolytic agents is helpful in manual removal of cerumen in patients who exhibit hard, dry wax.
Primary options
acetic acid otic: (2%) 1 dropperful into the affected ear(s)
More acetic acid oticApplied by the clinician to soften wax prior to manual removal or irrigation. Patient may be instructed to use daily for a few days prior to another attempt at manual removal or irrigation.
OR
docusate sodium otic: 1 dropperful into the affected ear(s)
More docusate sodium oticApplied by the clinician to soften wax prior to manual removal or irrigation.
OR
hydrogen peroxide otic: 1 dropperful into the affected ear(s)
More hydrogen peroxide oticApplied by the clinician to soften wax prior to manual removal or irrigation. Children may be frightened by the bubbly sound.
OR
normal saline: 1 dropperful into the affected ear(s)
More normal salineApplied by the clinician to soften wax prior to manual removal or irrigation. Patient may be instructed to use daily for a few days prior to another attempt at manual removal or irrigation.
OR
olive oil otic: 1 dropperful into the affected ear(s)
More olive oil oticApplied by the clinician to soften wax prior to manual removal or irrigation. Patient may be instructed to use daily for a few days prior to another attempt at manual removal or irrigation.
OR
mineral oil otic: 1 dropperful into the affected ear(s)
More mineral oil oticApplied by the clinician to soften wax prior to manual removal or irrigation. Patient may be instructed to use daily for a few days prior to another attempt at manual removal or irrigation.
OR
carbamide peroxide otic: (6.5%) 5-10 drops into the affected ear(s) twice daily
More carbamide peroxide oticIt is most effective if used by the patient in conjunction with warm water irrigation using a soft ear syringe (baby bulb syringe).
Choose a patient group to see our recommendations
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer
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