Is a curette (curet) suitable for removing earwax?

Is a Curette Suitable for Removing Earwax?

Yes, a curette is an effective and appropriate method for removing impacted earwax, and is one of three recommended treatment options by the American Academy of Otolaryngology-Head and Neck Surgery. 1

Three Equally Effective Treatment Options

The American Academy of Otolaryngology-Head and Neck Surgery recognizes three therapeutic approaches for cerumen impaction, with no head-to-head trials demonstrating superiority of one over another: 1

• Irrigation (water flushing)
• Cerumenolytic agents (wax-softening drops)
• Manual removal with instrumentation (including curette, forceps, or suction)

These methods can be used alone or in combination, either on the same day or at intervals. 1

Manual Removal with Curette: Key Details

Procedure characteristics: 1

• The clinician inserts a curette, forceps, or suction tip into the ear canal
• The wax is dislodged and retracted
• Takes only a few minutes to perform
• Does not require anesthesia
• Provides immediate resolution of symptoms caused by cerumen impaction

Potential risks: 1

• Temporary dizziness
• Pain
• Eardrum rupture (rare)

When to Choose Curette Over Other Methods

Curette is particularly appropriate when: 1, 2

• Irrigation is contraindicated (perforated tympanic membrane, history of ear surgery, tympanostomy tubes, active otitis externa, ear canal stenosis)
• Cerumenolytic agents have failed
• Immediate visualization of the tympanic membrane is needed
• The patient cannot tolerate irrigation

Important Safety Considerations

Absolute contraindications to irrigation (making curette preferable): 2, 3, 4

• Nonintact tympanic membrane or history of perforation
• History of ear surgery (unless cleared by ENT)
• Presence of tympanostomy tubes
• Active otitis externa or ear infection
• Ear canal stenosis or exostoses

Modifying factors requiring caution with any method: 2

• Anticoagulant therapy
• Immunocompromised state
• Diabetes mellitus
• Prior radiation therapy to head and neck

Comparative Safety Profile

One systematic review found that syringing (irrigation) appears to result in a greater number of complications than mechanical removal using a curette. 5 Tympanic membrane perforation was observed in up to 1% of irrigation cases, with mechanical removal showing lower complication rates. 5

Common Pitfalls to Avoid

Never use these methods: 2, 3

• Cotton-tipped swabs (can push wax deeper, cause canal laceration, TM perforation, or ossicular dislocation)
• Ear candling (no evidence of efficacy; risk of burns, perforation, and hearing loss)

Treatment Algorithm

The American Academy of Otolaryngology-Head and Neck Surgery recommends this stepwise approach: 2

1. First-line: Cerumenolytic drops for 3-5 days
2. Second-line: Irrigation with body-temperature water (if no contraindications)
3. Third-line: Manual removal with curette by healthcare provider

However, if contraindications to irrigation exist or specialized equipment is available, proceeding directly to curette removal is entirely appropriate. 1, 2

Referral Considerations

Refer to otolaryngology if: 2

• Multiple treatment attempts are unsuccessful
• Specialized equipment or training for manual removal is lacking
• Patient has complex anatomy or multiple contraindications