From the Guidelines
Cerumen impaction should be treated with observation, cerumenolytic agents, or irrigation, with the choice of treatment depending on patient presentation, preference, and clinical urgency, as these methods have been shown to be effective in resolving symptoms and improving quality of life 1. The symptoms of cerumen impaction can include pain, itching, sensation of fullness, tinnitus, odor, drainage, and cough, with complete occlusion potentially resulting in significant hearing loss, ranging from 5 to 40 dB depending on the degree of occlusion of the canal with cerumen 1. Some key points to consider when treating cerumen impaction include:
- The prevalence of cerumen impaction is high, affecting approximately 2% to 6% of the general population, with a higher incidence in the elderly and patients with cognitive impairment 1
- Treatment options should be selected based on the patient's individual needs and the clinician's training, skill, and experience 1
- Complications of treatment can occur, including tympanic membrane perforation, ear canal laceration, infection, bleeding, or hearing loss, at a rate of about 1 in 1000 ear irrigations 1
- Prevention of cerumen impaction involves regular cleaning of the outer ear with a washcloth and avoiding insertion of objects into the ear canal, as cerumen naturally migrates outward during jaw movements like chewing 1. It is essential to weigh the potential benefits and risks of each treatment option and to consider the patient's overall health and well-being when making a decision, with the goal of improving symptoms, preventing complications, and enhancing quality of life 1.
From the FDA Drug Label
Directions FOR USE IN THE EAR ONLY. Adults and children over 12 years of age: Tilt head sideways and place 5 to 10 drops into ear Tip of applicator should not enter ear canal Keep drops in ear for several minutes by keeping head tilted or placing cotton in the ear Use twice daily for up to 4 days if needed, or as directed by a doctor Any wax remaining after treatment may be removed by gently flusing the ear with warm water, using a soft rubber bulb ear syringe Warnings For use in the ear only Ask a doctor before use if you have ear drainage or discharge ear pain irritation, or rash in the ear dizziness an injury or perforation (hole) of the ear drum recently had ear surgery When using this product avoid contact with the eyes Stop use and ask a doctor if: you need to use for more than 4 days excessive earwax remains after use of this product
The symptoms of Cerumen (Earwax) impaction are not explicitly stated in the provided drug labels. Treatment options for Cerumen impaction include:
- Using hydrogen peroxide (OTIC) drops in the ear, as directed 2
- Gently flushing the ear with warm water using a soft rubber bulb ear syringe to remove any remaining wax after treatment 2 It is recommended to consult a doctor if you have certain conditions, such as ear drainage or discharge, ear pain, or an injury or perforation of the ear drum, before using hydrogen peroxide (OTIC) 3.
From the Research
Symptoms of Cerumen Impaction
- Hearing loss 4
- Itching 4
- Pain 4
- Tinnitus 4
- Fever, speech delay, or parental concerns in young children 4
- Behavioral changes in nonverbal patients 4
Treatment Options for Cerumen Impaction
- Cerumenolytic agents [(4, 5)]
- Irrigation with or without cerumenolytic pretreatment [(4, 5)]
- Manual removal [(4, 5)]
- Home irrigation with a bulb syringe for selected adults 4
- Avoidance of cotton-tipped swabs, ear candling, and olive oil drops or sprays 4
Contraindications and Special Considerations
- Patients with coagulopathies, hepatic failure, thrombocytopenia, or hemophilia 4
- Patients taking antiplatelet or anticoagulant medications 4
- Referral to an otolaryngologist if multiple attempts to remove impacted cerumen are ineffective [(4, 5)]
- Further evaluation for alternative diagnosis if symptoms persist despite resolution of impaction 4