Cerumen Removal

• 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.

Figure 1 :  Cerumen removal

View Larger Image

Figure 3 :  Equipment

View Larger Image

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

Figure 7 :  Proper method of ear irrigation

View Larger Image

Figure 9 :  Manual extraction methods

View Larger Image

• Unsuccessful removal
• Post-removal discomfort
• Tympanic membrane perforation
• Ossicle disruption
• EAC injury
• Infection

Figure 10 :  Re-examine the ear after the procedure

View Larger Image