From the Guidelines
Impacted cerumen should be treated with an appropriate intervention, which may include cerumenolytic agents, irrigation, or manual removal other than irrigation, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1.
Diagnosis and Treatment
Impacted cerumen, commonly known as earwax blockage, occurs when earwax accumulates and hardens in the ear canal, potentially causing hearing loss, discomfort, or infection. The diagnosis of cerumen impaction is made when an accumulation of cerumen causes symptoms, prevents needed assessment of the ear, or both 1.
- Clinicians should assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as nonintact tympanic membrane, ear canal stenosis, exostoses, diabetes mellitus, immunocompromised state, or anticoagulant therapy 1.
- The clinician should examine patients with hearing aids for the presence of cerumen impaction during a healthcare encounter 1.
Management Options
For mild cases, over-the-counter ear drops containing carbamide peroxide, hydrogen peroxide, or mineral oil can be used twice daily for 3-5 days to soften the wax 1.
- After applying drops, wait 5-10 minutes before tilting your head to let the softened wax drain out.
- Alternatively, a bulb syringe with warm water (body temperature) can gently irrigate the ear.
- For stubborn impactions, healthcare providers can perform professional removal using specialized tools like curettes or suction 1.
Prevention
Prevention involves avoiding cotton swabs, which often push wax deeper, and instead cleaning only the outer ear with a washcloth 1.
- Those who produce excessive earwax may benefit from periodic preventive use of softening drops.
- Earwax actually serves protective functions by trapping dust and repelling water, so complete removal isn't necessary or desirable.
When to Seek Medical Attention
Seek medical attention if you experience ear pain, drainage, significant hearing loss, or if you have a history of ear surgery, perforated eardrum, or ear tubes 1.
- Patients with symptoms of hearing loss, ear fullness, and ear pain should seek medical evaluation to rule out other conditions such as otitis media, otitis externa, or sudden inner ear hearing loss 1.
From the Research
Definition and Symptoms of Impacted Cerumen
- Impacted cerumen is a condition where earwax becomes stuck in the ear canal, causing symptoms such as hearing loss, pain, or dizziness 2, 3.
- It can also interfere with the examination of the tympanic membrane and prevent assessment of the external auditory canal or audiovestibular system 2, 3.
Treatment Options for Impacted Cerumen
- Treatment options for impacted cerumen include watchful waiting, manual removal, the use of ceruminolytic agents, and irrigation with or without ceruminolytic pretreatment 2.
- Cerumenolytics and irrigation of the ear canal are reasonable first-line therapies and can be used in conjunction or isolation 4.
- Manual removal is appropriate if irrigation and cerumenolytics are contraindicated, but specialized training may be required to prevent adverse outcomes 4.
Effectiveness of Cerumenolytic Products
- Some studies have found that ceruminolytic products such as Cerumenex and Murine are no more effective than a saline placebo in removing earwax 5.
- However, other studies have found that certain cerumenolytics such as sodium bicarbonate, paradichlorobenzene, and chlorobutanol are associated with significantly greater proportions of patients with wax clearance following syringing 6.
Referral to an Otolaryngologist
- Referral to an otolaryngologist is indicated if treatment with a ceruminolytic agent followed by irrigation is ineffective, if manual removal is not possible, or if the patient develops severe pain or has vertigo during irrigation 2, 3.
- Referral is also indicated if hearing loss is still present after cerumen has been removed or if multiple attempts to remove the impacted cerumen are ineffective 2, 3.