Clinical Practice Guideline

Cerumen Impaction

Treatment of Cerumen Impaction

(Endorsed, April 2013)

The guideline, Treatment of Cerumen Impaction, was developed by the American Academy of Otolaryngology-Head and Neck Surgery and endorsed by the American Academy of Family Physicians.

Key Recommendations

  • An individual should be diagnosed when an accumulation of cerumen is associated with symptoms, or prevents needed assessment of the ear (the external auditory canal or tympanic membrane), or both.
  • An individual with cerumen impaction should be assessed by history and/or physical examination for factors that modify management, such as one or more of the following: nonintact tympanic membrane, ear canal stenosis, exostoses, diabetes mellitus, immunocompromised state, or anticoagulant therapy.
  • Individuals with hearing aids should be examined for the presence of cerumen impaction during a health care encounter (examination more frequently than every three months, however, is not deemed necessary).
  • An individual with cerumen impaction should be treated with an appropriate intervention, which may include one or more of the following: cerumenolytic agents, irrigation, or manual removal other than irrigation.
  • Individuals should be reassessed at the conclusion of in-office treatment of cerumen impaction and the resolution of impaction should be documented. If the impaction is not resolved, additional treatment should be prescribed. If full or partial symptoms presist despite resolution of impaction, alternative diagnoses should be considered.

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.