ear wax removal

Indications

• symptomatic cerumen impactation
• need to visualize obscured tympanic membrane

Contraindications

• ear lavage
  • patients who cannot cooperate or maintain head in an immobile position
  • otitis externa
  • suspected perforation of the tympanic membrane

Procedure

• pretreatment to loosen ear wax
  • Cerumenex
  • docusate Na+ (Colace) liquid 1 mL, drain after 15 minutes
  • carbamide peroxide (Debrox) 5-10 drops BID for 4 days; allow to remain in ear for 15 minutes
• irrigation solution (water) should be body temperature to avoid the vestibular reflex, resulting in vertigo, nausea & vomiting
• the stream should NOT be aimed directly at the tympanic membrane
• pretreatment with Cerumenex may be indicated

Instrument removal technique:

• blunt ear curette (Buck) size 0 or 00
• wire curette (cerumen spoon)
• otoscope
• suction device

Complications

• malignant otitis media due to Pseudomonas aeruginosa in patients with diabetes mellitus

Notes

• lack of evidence supporting candling

More general terms

• clinical procedure

Additional terms

• cerumen
• triethanolamine polypeptide oleate-condensate (Cerumenex)