Otolaryngology Book

http://www.fpnotebook.com/

Cerumen Impaction

Advertisement

  1. Mechanism
    1. Apocrine/Sebaceous Gland secretions produce cerumen
      1. Located in skin lining outer half of canal
      2. Cerumen acidifies canal with lysozymes
        1. Prevents bacterial and fungal growth
      3. Cerumen is lipid rich and therefore hydrophobic
        1. Prevents skin penetration and maceration
    2. Impaction occurs from attempts to remove cerumen
    3. Exacerbated by swimming and showering
      1. Water moistens and expands cerumen
  2. Symptoms
    1. Otalgia
      1. Cerumen impaction is painless, unless:
        1. Cerumen touches tympanic membrane
        2. Cerumen injures external canal
    2. Hearing Loss
      1. Requires completely obscured canal
      2. Even a tiny hole of patency will maintain hearing
    3. Vertigo or disequilibrium
      1. Associated with cerumen touching tympanic membrane
  3. Indications for removal of cerumen
    1. Hearing Loss
    2. Otalgia
    3. Cerumen obscures exam
      1. Diagnosis requires 75% of tympanic membrane viewed
      2. Ear evaluation requires cerumen removal in 33% cases
      3. Children under age 1 year more often require removal
  4. Management
    1. Cerumen Softening Agents
      1. Debrox drops
      2. Acetic acid 1.5% with water
      3. Hydrogen peroxide or Benzalkonium chloride
    2. Office cerumen removal
      1. Manual Cerumen Removal
      2. Warm Water Ear Lavage
      3. Cerumen removal by Ear Canal Suction
      4. Cerumen softening before irrigation not effective
        1. Agents showed not benefit compared with saline
          1. Triethanolamine polypeptide (Cerumenex) drops
          2. Docusate Sodium 1 ml
          3. Carbamide Peroxide
        2. References
          1. Whatley (2003) Arch Pediatr Adolesc Med 157:1177
          2. Roland (2004) Arch Otolaryngol Head Neck Surg :
  5. Prevention
    1. Do not use cotton swabs in the ear canal
    2. Only further impacts present cerumen
  6. References
    1. Singer (2000) Ann Emerg Med 36:228

Navigation Tree