Differential Diagnosis for Increased Cérumen

• Single most likely diagnosis
  • Cerumen impaction: This is the most common cause of increased cérumen, often due to excessive production or improper removal techniques, leading to a blockage in the ear canal.
• Other Likely diagnoses
  • Earwax buildup due to narrow ear canals: Individuals with naturally narrower ear canals are more prone to cérumen accumulation.
  • Use of earplugs, headphones, or hearing aids: These devices can push cérumen further into the ear canal, causing a buildup.
  • Aging: Older adults often experience a decrease in the self-cleaning mechanism of the ear canal, leading to increased cérumen.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Middle ear tumor: Although rare, a tumor in the middle ear could cause an increase in cérumen production or accumulation as a secondary effect.
  • Cholesteatoma: A type of skin cyst in the middle ear that can be dangerous if left untreated, potentially causing damage to the surrounding bone and tissue.
• Rare diagnoses
  • Keratosis obturans: A rare condition characterized by an overgrowth of skin cells in the ear canal, which can lead to a blockage.
  • Cérumen gland tumors: Benign or malignant tumors of the glands that produce earwax, which are extremely rare but could cause an abnormal increase in cérumen.