From the Guidelines
Cerumen impaction can cause a range of symptoms, including hearing loss, ear fullness, itching, tinnitus, ear pain, and occasionally dizziness or cough, and treatment options include home remedies, professional removal, and prevention strategies to reduce recurrence 1.
Symptoms of Cerumen Impaction
The symptoms of cerumen impaction can vary, but common symptoms include:
- Hearing loss, which can range from 5 to 40 dB depending on the degree of occlusion of the canal with cerumen
- Ear fullness
- Itching
- Tinnitus (ringing in the ears)
- Ear pain
- Occasionally, dizziness or cough These symptoms can significantly impact a person's quality of life, and treatment is often necessary to alleviate them.
Treatment Options
Treatment options for cerumen impaction include:
- Home remedies, such as over-the-counter earwax softening drops (e.g., carbamide peroxide, mineral oil, or glycerin) used for 1-2 days, followed by gentle irrigation with warm water using a rubber bulb syringe
- Professional removal by a healthcare provider, which may involve manual removal with specialized instruments, irrigation with water, or suction
- Prevention strategies, such as avoiding cotton swabs or objects inserted into the ear canal, and cleaning only the outer ear with a washcloth
Prevention Strategies
Prevention strategies can help reduce the recurrence of cerumen impaction, and may include:
- Instilling prophylactic topical preparations
- Irrigating the ear canal
- Cleaning hearing aids
- Routine cleaning of the ear canal by a clinician
- Using wax-softening drops or home irrigation kits as part of an ear hygiene regimen These strategies can help prevent the accumulation of cerumen and reduce the risk of impaction, particularly in individuals with a history of recurrent impactions 1.
Complications of Treatment
While treatment of cerumen impaction is generally safe, complications can occur, including:
- Tympanic membrane perforation
- Ear canal laceration
- Infection of the ear
- Hearing loss
- Otitis externa (sometimes secondary to external auditory canal trauma)
- Pain
- Dizziness
- Syncope These complications can be serious, and it is essential to weigh the risks and benefits of treatment options carefully 1.
From the Research
Symptoms of Cerumen Impaction
Treatment Options for Cerumen Impaction
- Cerumenolytic agents [(2,3)]
- Irrigation with or without cerumenolytic pretreatment [(2,3)]
- Manual removal [(2,3)]
- Home irrigation with a bulb syringe (for selected adults) 2
Precautions and Considerations
- Patients with coagulopathies, hepatic failure, thrombocytopenia, or hemophilia, and those taking antiplatelet or anticoagulant medications, should be counseled about the increased risk of bleeding in the external auditory canal when cerumen is removed 2
- Cotton-tipped swabs, ear candling, and olive oil drops or sprays should be avoided 2
- Patients with persistent symptoms despite resolution of the impaction should be referred for further evaluation for an alternative diagnosis 2
- Patients with hard, spherical, or cylindrical objects in the ear canal should be referred to an otolaryngologist if previous removal attempts have failed or if there is ear trauma 3