HEENT 12: Impacted Cerumen (Ear Wax)

Question 1

What are the risk factors for impacted cerumen? (7)

Answer 1

• overproduction of cerumen – idiopathic, trauma
• anatomic variations in ear canal – excess narrowing, canal curvature, ear hair
• migration failure – aging changes cerumen production and skin in ear
• foreign objects placed in ear – hearing aids, in-ear speakers, ear plugs
• inappropriate attempts at removal or excessive cleaning – Q-tip use
• history of prior impaction
• older age – atrophy of ceruminous glands

Question 2

What are the signs and symptoms of impacted cerumen? (4)

Answer 2

• hearing loss
• ear discomfort – fullness, pruritus, mild ear pain, - tinnitus
• dizziness or vertigo
• chronic cough

Question 3

When is referral required? (9)

Answer 3

• patient unable to communicate symptoms
• rash or ear infection suspected
• history of ear surgery or tubes in ear
• history of ear infections – otitis media, otitis externa
• prior head/neck radiation
• foreign object in ear
• immunocompromised or diabetes
• increased bleed risk
• bleeding/discharge from ear, dizziness, pain (mod to sev), tinnitus (mod to sev), significant hearing loss

Question 4

What are the 3 main treatment options?

Answer 4

• irrigation
• manual removal
• cerumenolytic agents

Question 5

What are the contraindications to cerumenolytic use? (3)

Answer 5

• non-intact tympanic membrane
• active or history of ear infections
• tympanostomy tubes

Question 6

Oil-based Cerumenolytic

Answer 6

olive oil, mineral oil, almond oil

• duration: 4 days
• soften cerumen, lubricate ear canal/wax plug
• may not effectively disintegrate cerumen

Question 7

Water-based Cerumenolytic

Answer 7

water/saline/hydrogen peroxide 3%
docusate sodium 10 mg/mL
sodium bicarbonate 10%

• duration: 3-4 days
• inducing hydration, expand and loosen or fragment wax plugs

Question 8

Non-Water, Non-Oil-based Cerumenolytic

Answer 8

carbamide peroxide 6.5% (Murine) – hydrogen peroxide and urea

• duration: 4 days
• expands and loosens or fragments wax plugs
• may exacerbate dryness of ear canal

Question 9

When should patients feel relief of symptoms?

Answer 9

• within 3-4 days
• within 5-7 days with use of oil-based products

Question 10

Are prevention methods recommended?

Answer 10

no – ear is self-cleaning

• may be suitable for frequent impaction and known risk factors

Question 11

What are some prevention methods? (4)

Answer 11

• regular ear exams
• avoid use of objects in ear (worsening obstruction)
• cerumenolytics (water-based or carbamide peroxide)
• self-irrigation