cerumen impactation (obstruction)

Etiology

(risk factors)

• hearing aids
• excessive ear canal hair
• benign bony growths in the ear canal

Pathology

• external auditory canal may be completely occluded
• conductive hearing loss

Clinical manifestations

• acute unilateral hearing impairment
• gradual hearing impairment
• dizziness
• pain or itching
• chronic cough

Diagnostic procedures

• Weber test:
  • with conductive hearing loss, sound is perceived as greater in the affected ear
• Rinne test:
  • generally normal because cerumen impactation is associated with mild conductive hearing loss
  • ONLY when conductive hearing loss becomes moderate (not mild) does sound heard via air conduction vs bone conduction become closer to 1:1

Management

• see ear wax removal
• peroxide-based otic (cerumenolytic)
• ear irrigation* (water or saline at room temperature)
  • indications
    • patient is symptomatic
    • evaluation of the tympanic membrane
• manual removal with instrumentation
• clinical observation

* ear irrigation is indicated only if patient is symptomatic or it is necessary to visualize tympanic membrane

Notes

• lack of evidence supporting candling

More general terms

• external ear disease

Additional terms

• cerumen
• ear wax removal