Cerumen impaction



  • Pain, hearing loss, vertigo, disequilibrium
  • Visualization of symptomatic TM


  • TM rupture or myringotomy tubes

Equipment Needed

  • Warm Water
  • 5 or 10 cc syringe
  • Soft tubing from catheter


Three Methods

  • Cerumenolytic agents
    • Water based
      • acetic acid, colace, hydrogen peroxide, sodium bicarbonate, sterile saline
    • Oil Based
      • Almond oil, Peanut oil, Olive oil, Mineral oil
    • Debrox
  • Irrigation
    • 5 cc syringe with warm water and soft tubing from catheter
    • Jet lavage
    • Repeat until wax flushed out
  • Manual Removal
    • Perform under direct visualization
    • Soft, disposable plastic variety preferred to metal cerumen spoon/curettes


  • Increased risk of infection in immune compromised patients
  • Hemorrhage or hematoma in patients on anticouagulation
  • Irrigating with cold or hot solution may lead to vertigo, nausea, vomiting

See Also

External Links



  1. Buttaravoli and Hulsey, Cerumen Impaction, Chapter 26, Minor Emergencies, 3rd edition, 2013


Matthew Rosen