Cerumen Impaction

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Read the guidelines for AAFP endorsements.

AAFP Endorsed Recommendations

Endorsement of the Clinical Practice Guideline for Cerumen Impaction

The panel made a strong recommendation that clinicians should treat cerumen impaction that causes symptoms expressed by the patient or prevents clinical examination when
warranted.

The panel made recommendations that:

  1. Clinicians should diagnose cerumen impaction 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;
  2. Clinicians should assess the patient with cerumen impaction 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;
  3. The clinician should examine patients with hearing aids for the presence of cerumen impaction during a healthcare encounter (examination more frequently than every three months, however, is not deemed necessary);
  4. Clinicians should treat the patient with cerumen impaction with an appropriate intervention, which may include one or more of the following: cerumenolytic agents, irrigation,
    or manual removal other than irrigation; and
  5. Clinicians should assess patients at the conclusion of in-office treatment of cerumen impaction and document the resolution of impaction. If the impaction is not resolved, the clinician should prescribe additional treatment. If full or partial symptoms persist  despite resolution of impaction, alternative diagnoses should be considered.

AAO-HNS Clinical Practice Guideline: Cerumen Impaction (21 page PDF) -- (Endorsed June 2008)