Cerumen removal

• Cerumen composed of secretions of the sebaceous and ceruminous glands located in the lateral 1/3 of the ear canal mixed with desquamated skin and skin flora bacteria

• Migratory pattern of epithelium lining the ear canal is medial to lateral

• Reasons for cerumen accumulation: bony obstructions, eczema, autoimmune disease, narrowing of the ear canal, failure of epithelial migration with aging, hearing aids, ear plugs, overproduction of wax

  Patient presentation

• Hearing loss

• Earache

• Ear fullness

• Itchiness

• Dizziness

• Ringing in the ears (tinnitus)

• (need a ICD 10 diagnosis to bill)

Cerumen removal

• Cerumenolytics: mineral oil or docusate sodium

• Evidence Based Practice: shows that cerumenolytics improve the success of subsequent ear lavage. 5-10 ear gtts 2 x day for 4 days

• Irrigate with a large syringe (at least 30cc) with a large gauge angiocath with needle removed (16-18 gauge)

• Warm water and bacteriostatic agent such as hydrogen peroxide

• Direct the stream upwards in the ear canal

• Tip of the syringe no more than 8mm in to the canal

• Manual removal with an ear curette if at the canal orifice

Cerumen removal pearls

• No evidence for efficacy of mechanical jet irrigators, elephant ear wash device or syringe with angiocath just as efficacious

• Consider treating diabetics and immunosuppressed patients with fluoroquinolone ear drops for 5 days post lavage

• Rare complications: ear pain, bleeding (caution with patient’s on anticoagulation therapy) laceration and TM perforation