Clinical Practice Guideline

Earwax (Cerumen Impaction)

(Endorsed, August 2016)

The updated guideline, Earwax (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

  • Individuals with an accumulation of cerumen should be counseled on proper ear hygiene to prevent cerumen impaction.
  • An individual should be diagnosed with cerumen impaction when an accumulation of cerumen is associated with symptoms, prevents needed assessment of the ear, or both.
  • Individuals 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 who are asymptomatic and whose ears can be adequately examined should not be routinely treated for cerumen accumulation.
  • Individuals with obstructing cerumen in the ear canal who may not be able to express symptoms (young children and cognitively-impaired children and adults) should be identified and the need for intervention promptly evaluated.
  • Individuals with hearing aids should be examined for the presence of cerumen impaction.
  • An individual with cerumen impaction should be treated with an appropriate intervention, including one or more of the following: cerumenolytic agents, irrigation, or manual removal requiring instrumentation. Individuals should be discouraged from using ear candling for the treatment or prevention of cerumen impaction.
  • 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 persist 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.