Cerumen Impaction: An Updated Guideline from the AAO–HNSF
Am Fam Physician. 2017 Aug 15;96(4):263-264.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• Cerumen impaction should be diagnosed when an accumulation precludes an ear evaluation or when the accumulation is confirmed by otoscopy in a person who has symptoms.
• Each time a person with hearing aids presents to the office, otoscopy should be performed to evaluate for cerumen.
• Patients presenting with cerumen impaction should be appropriately treated with a cerumenolytic agent, irrigation, or manual removal.
From the AFP Editors
Although there are benefits to cerumen, including cleaning and protecting the ear canal, it can also cause blockages that can lead to loss of hearing, tinnitus, otalgia, itching, and other symptoms. In the United States, approximately 12 million persons present for problems related to cerumen, with about 8 million removal procedures performed. This update from the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO–HNSF) provides guidance for persons older than six months diagnosed with cerumen impaction.
For persons presenting with accumulated cerumen, physicians should discuss appropriate ear hygiene to prevent impaction. Many persons commonly perform ear hygiene measures; therefore, the discussion should be focused on safe and effective regimens that also avoid such harms as scrapes or unintended impaction caused by manipulation. Preventive methods may be needed for persons who have a history of impaction or greater likelihood of an occlusion, including children, older persons, persons with cognitive impairment, and persons who wear hearing aids. Options to limit accumulation include cerumenolytic drops and irrigation. Patients should be advised against using cotton swabs or small objects to clean the ear.
Cerumen impaction should be diagnosed when an accumulation precludes an ear evaluation or when the accumulation is confirmed by otoscopy in a person who has symptoms. Persons who are at risk of impaction but are unable to indicate the presence
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
Copyright © 2017 by the American Academy of Family Physicians.
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