Clinical practice guideline: Cerumen impaction

Roland, Peter S.; Smith, Timothy L.; Schwartz, Seth; Rosenfeld, Richard M.; Ballachanda, Bopanna B.; Earll, Jerry M.; Fayad, Jose N.; Harlor, Allen D. “Buz”; Hirsch, Barry E.; Jones, Stacie; Krouse, Helene J.; Magit, Anthony; Nelson, Carl; Stutz, David R.; Wetmore, Stephen J.

doi:10.1016/j.otohns.2008.06.026

Cited by 126 publications

(160 citation statements)

References 71 publications

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“…Cerumen may be removed by using a curette, gentle suction, or irrigation. 48 The pneumatic otoscope should have a light source of sufficient brightness and an air-tight seal that permits application of positive and negative pressure. In general, nondisposable specula achieve a better seal with less pain because of a thicker, smoother edge and better light transmission properties.…”

Section: Examination Of the Tmmentioning

confidence: 99%

The Diagnosis and Management of Acute Otitis Media

Tunkel

Rosenfeld²,

Sevilla³

et al. 2013

Pediatrics

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1,058

832

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This evidence-based clinical practice guideline is a revision of the 2004 acute otitis media (AOM) guideline from the American Academy of Pediatrics (AAP) and American Academy of Family Physicians. It provides recommendations to primary care clinicians for the management of children from 6 months through 12 years of age with uncomplicated AOM.In 2009, the AAP convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report and other sources of data were used to formulate the practice guideline recommendations.The focus of this practice guideline is the appropriate diagnosis and initial treatment of a child presenting with AOM. The guideline provides a specific, stringent definition of AOM. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures. It also addresses recurrent AOM, which was not included in the 2004 guideline. Decisions were made on the basis of a systematic grading of the quality of evidence and benefit-harm relationships.The practice guideline underwent comprehensive peer review before formal approval by the AAP.This clinical practice guideline is not intended as a sole source of guidance in the management of children with AOM. Rather, it is intended to assist primary care clinicians by providing a framework for clinical decision-making. It is not intended to replace clinical judgment or establish a protocol for all children with this condition. These recommendations may not provide the only appropriate approach to the management of this problem. Pediatrics 2013;131:e964-e999

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Section: Examination Of the Tmmentioning

confidence: 99%

The Diagnosis and Management of Acute Otitis Media

Tunkel

Rosenfeld²,

Sevilla³

et al. 2013

Pediatrics

Self Cite

1,058

832

View full text Add to dashboard Cite

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“…As a consequence, it is likely that services will vary with many based primarily on local custom and practice rather than a strong clinical evidence base. Some locally and internationally based guidelines have been developed 28 and these, along with opinions from clinicians, including practice nurses, provide a basis for understanding the clinical pathway that may be followed by people who are suffering from the problems associated with excessive earwax. Problems that may lead a person to seek help include a feeling of a blockage, discomfort, hearing loss in one or both ears, tinnitus and/or dizziness.…”

Section: Current Service Provision and Description Of Interventionsmentioning

confidence: 99%

The safety and effectiveness of different methods of earwax removal: a systematic review and economic evaluation

2010

Clinical Governance: An International Journal

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How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).Printed copies of HTA journal series issues cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our despatch agents.Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per issue and for the rest of the world £3 per issue. How to order:-fax (with credit card details) -post (with credit card details or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you to either print out your order or download a blank order form. Contact details are as follows:Synergie UK (HTA Department) Digital House, The Loddon Centre Wade Road Basingstoke Hants RG24 8QW Email: orders@hta.ac.uk Tel: 0845 812 4000 -ask for 'HTA Payment Services' (out-of-hours answer-phone service) Fax: 0845 812 4001 -put 'HTA Order' on the fax header Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to University of Southampton and drawn on a bank with a UK address. Paying by credit cardYou can order using your credit card by phone, fax or post. SubscriptionsNHS libraries can subscribe free of charge. Public libraries can subscribe at a reduced cost of £100 for each volume (normally comprising 40-50 titles). The commercial subscription rate is £400 per volume (addresses within the UK) and £600 per volume (addresses outside the UK). Please see our website for details. Subscriptions can be purchased only for the current or forthcoming volume. How do I get a copy of HTA on DVD?Please use the form on the HTA website (www.hta.ac.uk/htacd/index.shtml). HTA on DVD is currently free of charge worldwide.The website also provides information about the HTA programme and lists the membership of the various committees. HTA NIHR Health Technology Assessment programmeT he Health Technology Assessment (HTA) programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The research findings from the HTA programme directly influence decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC). HTA findings also help to improve the quality of clinical practice in the NHS indirectly in that they form a key component of the 'National Knowledge Service'. The HTA programme is needs led in that it fills gaps in the evidence needed by the NHS. There are three routes to the start of projects...

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“…1 To remove symptomatic wax, current professional guidelines advocate the use of ear drops to soften wax, followed, if necessary, by irrigation by a trained clinician. 2 In UK family practice, although ear irrigation is now carried out more often by family practice nurses than by physicians, 3 it still represents a signifi cant health cost.…”

Section: Introductionmentioning

confidence: 99%

Randomized Trial of Bulb Syringes for Earwax: Impact on Health Service Utilization

Coppin¹,

Wicke²,

Little³

2011

The Annals of Family Medicine

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PURPOSE Bulb syringes can be used for the self-clearance of earwax and, in the short term, appear effective. We compared the long-term effectiveness of selfirrigation using a bulb syringe with routine care in United Kingdom (UK) family practice clinics where irrigating ears to remove wax is a common procedure. METHODSWe assessed the impact on health service utilization as a follow-up to a single-blind, randomized, controlled trial of 237 patients attending 7 UK family practice clinics with symptomatic, occluding earwax who were randomized to an intervention group (ear drops, bulb syringe, instructions on its use and re-use) or a control group (ear drops, then clinic irrigation). After 2 years, a retrospective notes search for earwax-related consultations was carried out. We used an intention-totreat analysis to assess differences in dichotomous outcomes between groups.

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Clinical practice guideline: Cerumen impaction

Cited by 126 publications

References 71 publications

The Diagnosis and Management of Acute Otitis Media

The Diagnosis and Management of Acute Otitis Media

The safety and effectiveness of different methods of earwax removal: a systematic review and economic evaluation

Randomized Trial of Bulb Syringes for Earwax: Impact on Health Service Utilization

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