Cerumen impaction

Overview

Indications

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

Contraindications

  • TM rupture or myringotomy tubes

Equipment Needed

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

Procedure

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

Complications

  • 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

References

[1]

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

Authors:

Matthew Rosen