to the editor: I would like to add a recommendation for cerumen removal to those made by the authors of “Cerumen Impaction” in the May 15, 2007, issue of American Family Physician.1 A common technique used by physicians to remove cerumen from the ear canal is to look with an otoscope, “memorize” the position of the cerumen (or an opening in the impaction through which one might insert an ear loop or spoon to get behind the impaction), put down the otoscope, and then insert the instrument blindly, based on the “mental picture.” This can lead to inaccurate placement of the instrument, trauma to the sensitive and fragile ear canal skin, bleeding, pain, and an upset patient. A common error is not inserting the instrument deeply enough, for fear of damaging the tympanic membrane. The problem is that the physician does not have enough hands to retract the pinna, hold a light source, and use an instrument. I found that trying to open the window of the otoscope and manipulating the instrument through it under direct vision is awkward and does not work well for me.
However, I found a solution that does work very well. Lighted curettes, which are plastic, disposable ear spoons/loops that attach to a light source and transmit light through the instrument allow retraction with one hand and manipulation of the instrument with the other hand. A magnification lens fits on the light source, though I have found it is not necessary. The light is more than sufficient to allow me to clearly see the impaction and for accurate placement of the instrument, increasing the safety, effectiveness, and comfort of the procedure. Also, it often eliminates the need for an unnecessary and time-consuming irrigation (if the wax is hard and dry and adherent to the ear canal skin, presoaking with a cerumen softener can still be helpful). These lighted curettes are really a pleasure to use. The system is inexpensive, costing approximately $80.
I imagine that using standard steel instruments with an old-fashioned fenestrated head mirror, with a goose-neck lamp on the opposite side of the patient, would also work. I did not try that because the lighted loops worked so well.