Cerumen Removal (Emergency Medicine)

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  • Objective visualization of cerumen impaction on exam
  • Suspicion of cerumen impaction based on history and presence of secondary signs and symptoms
  • Multiple prior failed attempts and/or presence of complications from prior attempts including tympanic membrane (TM) perforation and infection.
  • Patient unable to cooperate
  • Infection, past or present TM perforation, history of ear or mastoid surgery
  • Contralateral deafness
  • Visualization
    • Adequate light source (head/ENT lamp, head reflector, otoscope)
    • Ear speculum (largest tolerated) with or without magnifying loops
  • Eye protection and/or face shield**UNIVERSAL PRECAUTIONS**
  • ceruminolytic (water vs. alcohol- or oil-based)
  • Ear curette, right-angle hook, Frazier suction
  • Syringing materials
    • 30-mL or 60-mL syringe
    • Angiocatheter or butterfly tubing
    • Irrigant warmed to body temperature
    • Basin
    • Towels
  • The inner one third of the canal is lined with skin that is only 0.1 mm thick, so special care should be taken to avoid iatrogenic traumatic injury to this area. 

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Re-examine canal for confirmation of removal and signs of complications.
  • Advise follow-up if the plan is for several days of wax-softening treatment and delayed removal, if initial removal attempts are unsuccessful, or if there are complications.
  • Provide appropriate aftercare instructions, including avoidance of cotton swabs and maintenance use of ceruminolytics.
  • Unsuccessful removal
  • Post-removal discomfort
  • Tympanic membrane perforation
  • Ossicle disruption
  • EAC injury
  • Infection
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