Cerumen Management: An Updated Clinical Review and Evidence-Based Approach for Primary Care Physicians

Abstract

Objective: To provide family physicians with a practical, evidence-based approach to managing patients with cerumen impaction. Methods: MEDLINE, The Cochrane Library, and the Turning Research Into Practice (TRIP) database were searched for English-language cerumen impaction guidelines and reviews. All such articles published between 1992 and 2018 were reviewed, with most providing level II and III evidence. Results: Cerumen impaction is a common presentation seen in primary care and cerumen removal is one of the most common otolaryngologic procedures performed in general practice. Cerumen impaction is often harmless but can be accompanied by more serious symptoms. Cerumenolytics and irrigation of the ear canal are reasonable first-line therapies and can be used in conjunction or isolation. If irrigation and cerumenolytics are contraindicated, manual removal is appropriate, but the tools necessary are not commonplace in primary care clinics and specialized training may be required to prevent adverse outcomes. Conclusion: Family physicians play a key role in the assessment and management of cerumen impaction and are well equipped to do so. Knowledge of the available techniques for cerumen removal as well as their contraindications ensures that cerumen is removed safely and effectively. When cerumen removal cannot be removed safely in a primary care setting, referral to Otolaryngology-Head and Neck Surgery is appropriate.

Cerumenolytics with or without manual extraction for impacted earwax: A network meta‐analysis of randomised clinical trials

“…In some patients, the cerumen can be very hard and cannot be removed with cerumenolytics alone. In such patients, manual removal of impacted cerumen using syringing/suction/aspiration can be attempted in family practice with appropriate training 11 . Until now, there is no evidence on the efficacy of cerumenolytics followed by extraction procedures.…”

Cerumen Impaction Removal in General Practices: A Comparison of Approved Standard Products

“…Cerumen impaction causes symptoms such as hearing loss, ear noise or ear pain and is a common reason for consultation in general practice. 1 , 2 About 5% of adults, 10% of children and one-third of geriatric and cognitively impaired individuals are affected. 3 , 4 Cerumen becomes drier at an older age due to atrophy of the cerumen glands.…”

“…This, together with the fact that hair in the ear canal becomes coarser with age, leads to a higher rate of cerumen impaction in elderly patients. 1 , 5 Furthermore, the natural self-cleaning mechanism can be inadequate and cerumen can become impacted, due to illness-related changes such as scaling skin disorders, for example, eczema and psoriasis, anatomical abnormalities of the ear canal and the routinely use of hearing aids or earplugs. 2 According to the Clinical Practice Guideline: Earwax (Cerumen Impaction) of the American Academy of Otolaryngology- Head and Neck Surgery , the following options are recommended for removing impacted cerumen: watchful-waiting, education, cerumenolytic agents, ear irrigation or other manual techniques for removing earwax (cerumen spoon, alligator forceps, suction, hook).…”

“…This procedure is fast, little time-consuming and rarely causes complications when performed by a well-trained practitioner. 1 , 8 If performed by a less experienced practitioner manual cerumen removal can cause ear canal trauma and perforation of the tympanic membrane. 9 Moreover, additional equipment such as headlamp or an ear microscope is needed to improve the safety of the manual removal.…”

The Assessment of antimicrobial activity of cerumen (earwax) and antibiotics against pathogenic bacteria isolated from ear pus samples

“…Cerumen type has been used by anthropologist to track human migratory patterns, such as those of Eskimas. 8 Further, the study of earwax has shown controversy, as some authors have suggested that earwax has high level of nutrients which help in microbial growth and other hold a view that earwax has some compounds that inhibit the growth of microorganisms and prevent ear infections. 9,10 Ear infection in any form has a varied microbial etiology, which influences the selection of an efficacious of anti-microbial agents.…”