CERUMEN IMPACTION Prevalence and Detection in Nursing Homes

“…When coupled with an increase in the number and coarseness of cilia in the ear canal, especially in males, the result is a linear increase in the percentage of elderly patients with excessive cerumen (Ruby, 1986;Gleitman et al, 1992). Of note is the work of Mahoney (1987Mahoney ( , 1993, who carried out longitudinal studies on the prevalence of excessive cerumen in nursing home residents and found 34-57% with "moderate to large" amounts of cerumen.…”

mentioning

confidence: 98%

Effect of Ear Canal Occlusion on Pure-Tone Threshold Sensitivity

Roeser

Lai²,

Clark³

2005

J Am Acad Audiol

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This study sought to quantify the effects of varying the degree of ear canal occlusion on pure-tone threshold sensitivity. Thresholds were obtained from each ear of five normal-hearing adults without occlusion, with complete occlusion, and with partial occlusion estimated to be 40-60% and 60-80%. A commercial lubricant was used in the completely occluded condition to eliminate possible acoustic leakage. Results showed a reduction of threshold sensitivity in all occluded conditions, with the greatest effect in frequencies above 1000 Hz. Only in the completely occluded condition were frequencies below 1000 Hz affected. In the partially occluded conditions, thresholds decreased by an average 7.5 dB and 13.0 dB across frequency for the 40-60% and 60-80% conditions respectively. At frequencies above 1000 Hz, the average threshold shifts for the two partially occluded conditions were 10.0 dB and 16.8 dB respectively. The implications of these findings on routine pure-tone audiometric procedures, with specific relevance for industrial hearing conservation programs, are discussed.

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“…Estimates suggest that between 19% and 65% of patients >65 years old have cerumen impaction 13,15 and that elderly patients in nursing homes are likely at the upper end of this spectrum. 10,18 In the developmentally delayed adult population, 28% to 36% have excessive or impacted cerumen. 10,11 Moreover, the presence of cerumen impaction has been associated with hearing loss 19 and diminished cognitive function 15 in these populations.…”

Section: Health Care Burdenmentioning

confidence: 99%

Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)

Schwartz

Magit

Rosenfeld

et al. 2017

Otolaryngol.--head neck surg.

119

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Objective. This update of the 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidencebased recommendations on managing cerumen impaction. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. Changes from the prior guideline include• a consumer added to the development group;• new evidence (3 guidelines, 5 systematic reviews, and 6 randomized controlled trials); • enhanced information on patient education and counseling; • a new algorithm to clarify action statement relationships;• expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences of opinion; • an enhanced external review process to include public comment and journal peer review; and • 3 new key action statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination of care.Purpose. The primary purpose of this guideline is to help clinicians identify patients with cerumen impaction who may benefit from intervention and to promote evidence-based management. Another purpose of the guideline is to highlight needs and management options in special populations or in patients who have modifying factors. The guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction, and it applies to any setting in which cerumen impaction would be identified, monitored, or managed. The guideline does not apply to patients with cerumen impaction associated with the following conditions: dermatologic diseases of the ear canal; recurrent otitis externa; keratosis obturans; prior radiation therapy affecting the ear; previous tympanoplasty/myringoplasty, canal wall down mastoidectomy, or other surgery affecting the ear canal.Key Action Statements. The panel made a strong recommendation that clinicians should treat, or refer to a clinician who can treat, cerumen impaction, defined as an accumulation of cerumen that is associated with symptoms, prevents needed assessment of the ear, or both.The panel made the following recommendations: (1) Clinicians should explain proper ear hygiene to prevent cerumen impaction when patients have an accumulation of cerumen. (2) Clinicians should diagnose cerumen impaction when an accumulation of cerumen, as seen on otoscopy, is associated with symptoms, prevents needed assessment of the ear, or both. (3) Clinicians should assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as ≥1 of the following: anticoagulant therapy, immunocompromised state, diabetes mellitus, prior radiation therapy to the head and neck, ear canal stenosis, exostoses, and nonintact tympanic membrane. (4) Clinicians should not routinely treat cerumen in patients who are asymptomatic and whose ears can be adequately examined. (5) Clinicians s...

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CERUMEN IMPACTION Prevalence and Detection in Nursing Homes

Cited by 20 publications

References 11 publications

Hearing Loss: Why Does It Matter for Nursing Homes?

Hearing Loss: Why Does It Matter for Nursing Homes?

Effect of Ear Canal Occlusion on Pure-Tone Threshold Sensitivity

Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)

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