Use of cerumenolytics see below is safe, but contraindications include a perforated tympanic membrane or a history of ear surgery, including tympanostomy tube placement. Common reactions include local irritation and a rash. With prolonged use, a superinfection may occur. When treatment is appropriate, there are three recommended removal methods: cerumenolytic agents, irrigation, and manual removal. These are typically water- or oil-based compounds, with water-based solutions being the most commonly used.
Typical ingredients found in water-based cerumenolytics include hydrogen peroxide, acetic acid, docusate sodium, and sodium bicarbonate. Common ingredients in oil-based cerumenolytics include peanut, olive, and almond oil.
Most drops are available over the counter. Typically, up to five drops are used per dose one to two times daily for three to seven days. A commonly prescribed cerumenolytic is carbamide peroxide. Five to 10 drops are placed twice daily for up to four days. The drops work by releasing oxygen to soften and encourage spontaneous extrusion of cerumen and also have a weak antibacterial effect. Irrigation is another method to safely and effectively remove unwanted cerumen, provided the tympanic membrane can be visualized first.
Several irrigation methods may be used in the clinical setting. Another option is a standard oral jet irrigator, with or without a modified tip.
Although these methods are inexpensive and generally safe, they can be potential causes of trauma, including perforation of the tympanic membrane. There are electronic irrigators available as well; however, there are no controlled trials to compare the different irrigation methods. Manual removal is the final method recommended by the American Academy of Otolaryngology-Head and Neck Surgery for the removal of unwanted cerumen.
Manual removal often requires specialized instrumentation for better visualization, such as a binocular microscope and a handheld speculum. Philadelphia, Pa. A quasi-randomised controlled trial of water as a quick softening agent of persistent earwax in general practice.
Robinson AC, Hawke M. The efficacy of ceruminolytics: everything old is new again. J Otolaryngol. Ceruminolytic efficacy in adults versus children. The mechanism of ceruminolysis. Clinical evaluation of ceruminolytic agents. Eye Ear Nose Throat Mon. Pavlidis C, Pickering JA. Water as a fast acting wax softening agent before ear syringing.
Aust Fam Physician. Effect of cotton-tipped swab use on ear-wax occlusion. Clin Pediatr Phila. Cotton-tip applicators as a leading cause of otitis externa. Int J Pediatr Otorhinolaryngol. Sim DW. Wax plugs and cotton buds. Ear candles—efficacy and safety. Ernst E. Ear candles: a triumph of ignorance over science. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Next: Predicting Postoperative Nausea and Vomiting. May 15, Issue. Cerumen Impaction. Cerumen is a naturally occurring, normally extruded product of the external auditory canal.
B 13 Systematic review of lowerquality studies The use of ceruminolytics may improve the effectiveness of irrigation. B 13 Systematic review of lower quality studies Applying water or a ceruminolytic 15 to 30 minutes before irrigation is as effective as applying a ceruminolytic for several days before irrigation.
B 13 , 25 Systematic reviews of lower quality studies No ceruminolytic is superior to any other or to saline. B 11 — 13 Systematic reviews of lower quality studies Ear candling should be avoided.
Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close.
Best Value! To see the full article, log in or purchase access. More in Pubmed Citation Related Articles. Earwax is produced by glands in the ear canal, which leads from the outer ear to the eardrum. Earwax helps protect the ear by trapping dust and other foreign particles that could damage the ear.
Normally, earwax moves toward the opening of the ear and falls out or is washed away, but some people's ears produce too much wax. The extra wax can build up and harden in the ear canal and become difficult to remove. Earwax also can become impacted when, during ear cleaning, the wax is accidentally pushed deeper into the ear canal.
Patients with coagulopathies, hepatic failure, thrombocytopenia, or hemophilia, and those taking antiplatelet or anticoagulant medications, should be counseled about the increased risk of bleeding in the external auditory canal when cerumen is removed. Effective treatment options include cerumenolytic agents, irrigation with or without cerumenolytic pretreatment, and manual removal.
Home irrigation with a bulb syringe may be appropriate for selected adults. Cotton-tipped swabs, ear candling, and olive oil drops or sprays should be avoided.
If multiple attempts to remove the impacted cerumen—including a combination of treatments—are ineffective, clinicians should refer the patient to an otolaryngologist. Persistent symptoms despite resolution of the impaction should also prompt further evaluation for an alternative diagnosis.
Cerumen, or earwax, is a combination of glandular secretions and desquamated epithelial cells that cleans, protects, and lubricates the external auditory canal. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms or prevents assessment of the ear canal, tympanic membrane, or audiovestibular system; complete obstruction is not required.
Enlarge Print. Cerumen impaction should be treated when it causes symptoms such as hearing loss, itching, pain, or tinnitus, or when it prevents assessment of the external auditory canal, tympanic membrane, or audiovestibular system. Cerumen should be removed when it limits examination in patients who cannot communicate their symptoms, such as those with dementia or developmental delay, nonverbal patients with behavioral changes, and young children with fever, speech delay, or parental concerns.
Irrigation, cerumenolytic agents, and manual removal with instrumentation are effective treatments for cerumen impaction. There is not enough evidence supporting the superiority of one option over another. Cotton-tipped swabs, ear candling, and olive oil drops or sprays should not be used to remove cerumen because they are ineffective and have potential adverse effects. The diagnosis of cerumen impaction is made by direct visualization with an otoscope.
Common symptoms include hearing loss, feeling of fullness in the ear, itching, otalgia, tinnitus, cough, and, rarely, a sensation of imbalance. In these patients, cerumen should be removed when it limits examination. A study of children one month to 12 years of age presenting with upper respiratory infection or for a well-child visit examined whether cerumen affected the diagnosis of acute otitis media. Cerumen was removed by pediatricians in less than one-third of the children compared with almost all of the children evaluated by otolaryngologists when a final diagnosis of acute otitis media was made.
Cerumen in the ear canal can compromise auditory or vestibular testing and should therefore be removed before these tests are performed. Cerumen does not affect temperature measurement with an ear thermometer. Patients with coagulopathies, hepatic failure, thrombocytopenia, or hemophilia and those taking antiplatelet or anticoagulant medications should be counseled about the increased risk of bleeding in the external auditory canal when cerumen is removed.
Clinicians should avoid traumatic irrigation or traumatic manual removal in these patients, or refer them to a subspecialist. Immunocompromised patients and those with uncontrolled diabetes mellitus are at increased risk of postprocedural otitis externa, especially when irrigation is performed.
Malignant otitis externa, a potentially life-threatening external auditory canal infection that spreads rapidly to the surrounding tissues and bones, has been reported with the use of tap water irrigation.
If irrigation is performed in at-risk patients, they should be counseled to follow up promptly if they develop fever, ear pain, or discharge. Patients with a history of head and neck radiation may have drier cerumen and require more careful debridement, because injury to the ear canal may evolve into osteoradionecrosis of the external auditory canal or temporal bone. Microscope-assisted mechanical removal of cerumen is the preferred technique in patients with a perforated tympanic membrane or who have a patent tympanostomy tube.
No intervention is required for cerumen that does not meet the definition of impaction, except in patients who cannot report their symptoms and who have a significant amount of cerumen that impairs examination. Three options are widely used to treat cerumen impaction: irrigation, cerumenolytic agents, and manual removal with instrumentation.
If the impaction is not resolved, additional treatments should be attempted. If the impaction is resolved but symptoms persist, an alternative diagnosis should be considered. Cerumenolytic agents are commonly used alone or in combination with irrigation or manual instrumentation to remove impacted cerumen.
Topical preparations are available in three forms: water-based, oil-based, and non—water or oil-based Table 1. Clinicians should ensure that the patient has no history of allergies to any of the components. Ear drops should be close to body temperature to avoid caloric effects vertigo , and should not be used if there is a possibility that the tympanic membrane is not intact, if a patent tympanostomy tube is present, or if the ear canal is infected. In one study, one-fifth of tympanic membranes were visualized without irrigation.
If not completely removed, bubbling may interfere with ability to visualize tympanic membrane. Fill affected ear with 2 to 3 mL 15 to 30 minutes before irrigation, or alternatively for three to 14 days at home with or without irrigation.
Can be irritating to the ear canal and should not be used for a prolonged period. If irrigation is attempted without softening and is ineffective after the first attempt, instill water and wait 15 minutes before repeating irrigation.
Choline salicylate plus glycerol e. Cerumen impaction. Am Fam Physician. Irrigation can be attempted alone or with cerumenolytic pre-treatment. Before performing aural irrigation, it is important to obtain a detailed history and to view the tympanic membrane and external auditory canal to ensure that the membrane is intact, that no patent tympanostomy tubes are present, and that there are no anatomic abnormalities.
There are several irrigation techniques using syringes or electronic irrigators, and although none has been proven superior, manual irrigation with a syringe is most often used.
0コメント