Cerumen removal

Overview

• Cerumen impaction is caused by the buildup of wax within the ear canal and can lead to decreased hearing, pressure or fullness, dizziness, tinnitus, or pain.

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 anticoagulation
• Irrigating with cold or hot solution may lead to vertigo, nausea, vomiting

External Links

Videos

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