Medical Terminology for Ear Debris
The medical term for debris in the ear is "cerumen impaction" when referring to earwax accumulation, or "aural foreign body" when referring to other materials. 1
Defining Cerumen Impaction
Cerumen impaction is diagnosed when an accumulation of cerumen (earwax) either causes symptoms (hearing loss, fullness, tinnitus, otalgia), prevents needed assessment of the ear, or both. 1, 2
Importantly, impaction doesn't require complete canal occlusion—even partial obstruction causing symptoms qualifies as impaction. 2
The term "keratin debris" is used when referring to accumulated dead skin cells, particularly in patients with exostoses or osteomas of the ear canal. 1
Clinical Presentation and Assessment
Patients may present with ear fullness, itching, otalgia, discharge, hearing loss, or tinnitus when cerumen becomes impacted. 3
Otoscopy should reveal accumulation of cerumen that either blocks visualization of the tympanic membrane or is associated with the patient's symptoms. 1
Before selecting a removal method, assess for modifying factors including: anticoagulant therapy, immunocompromised state, diabetes mellitus, prior head/neck radiation, ear canal stenosis, exostoses, or nonintact tympanic membrane. 1, 2
Management Approach
Treatment options include cerumenolytic agents, irrigation, or manual removal with instrumentation—the choice depends on contraindications, available equipment, and clinician training. 1, 2, 4
Water-based cerumenolytics (carbamide peroxide, hydrogen peroxide, saline, sodium bicarbonate) are first-line, with no single agent superior to plain water. 2, 5
Irrigation should use body-temperature water directed at the canal wall (not the tympanic membrane) to avoid caloric effects and minimize perforation risk (~0.2%). 2, 4
Critical Contraindications
Absolute contraindications to irrigation and most cerumenolytics include: perforated tympanic membrane, tympanostomy tubes, history of ear surgery, active otitis externa, and ear canal stenosis/exostoses. 1, 2, 4, 5
Immunocompromised patients (including those with diabetes) have higher risk of necrotizing otitis externa, especially with tap water irrigation. 1, 4
Strongly recommend against ear candling (risk of burns, perforation) and cotton-tipped swabs (push wax deeper, cause trauma). 1, 2, 6
When to Refer
Refer to otolaryngology if initial treatment fails, multiple attempts are unsuccessful, severe pain/vertigo develops during irrigation, or hearing loss persists despite cerumen clearance. 4, 5, 6, 7
Specialized equipment (binocular microscopes, microsuction) may be required for safe removal in complex cases. 4, 5