Best Practices and Treatment of Earwax Impaction. (Helpful “Dos” and “Don’ts” for a common problem)

18 Jan , 2017

Earwax or cerumen is a normal substance that the body produces to clean, protect, and “oil” ears. It acts as a self-cleaning agent to keep ears healthy. At times, the ear’s self-cleaning process might not work very well and may lead to a buildup of earwax. When this happens, earwax can collect and block, or partly block, the ear canal. Excessive or impacted cerumen is present in 1 in 10 children, 1 in 20 adults, and more than one-third of the geriatric and developmentally delayed populations, says AAO-HNSF.

An updated clinical practice guideline from the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF), Alexandria, Va, published in the January edition of Otolaryngology–Head and Neck Surgery is designed to provide evidence-based recommendations on the treatment of earwax (cerumen impaction), as well as important patient information on the dos and don’ts of earwax and healthy ear care.

A summary of the guidelines was also made available by AAO-HNS. The organization says the purpose of the updated guideline is to help patients with cerumen impaction who may benefit from intervention. The update features new evidence, including three clinical guidelines, five systematic reviews and six randomized controlled trials, as well as observational studies and an evolved methodology that included adding a patient representative to the guideline development group.

“Patients often think that they are preventing earwax from building up by cleaning out their ears with cotton swabs, paper clips, ear candles, or any number of unimaginable things that people put in their ears,” says Seth R. Schwartz, MD, MPH, chair of the guideline update group. “The problem is that this effort to eliminate earwax is only creating further issues because the earwax is just getting pushed down and impacted further into the ear canal. Anything that fits in the ear could cause serious harm to the ear drum and canal with the potential for temporary or even permanent damage.”

Impacted earwax can cause symptoms like ear pain, itching, feeling of fullness in the ear, ringing in the ear (tinnitus), hearing loss, discharge coming from the ear, odor coming from the ear, cough, and/or change in hearing aid function. The update provides a table of dos and don’ts for clinicians to further educate patients about cerumen impaction, including:

*DON’T overclean your ears. Excessive cleaning may irritate the ear canal, cause infection, and even increase the chances of cerumen impaction.

*DON’T put anything smaller than your elbow in your ear. Your mother was right! Cotton swabs, hair pins, care keys, toothpicks…these can all injure your ear and may cause a laceration (cut) in the ear canal, a perforation (hole) in the eardrum, and/or dislocation of the hearing bones, leading to hearing loss, dizziness, ringing, and other symptoms of ear injury.

*DON’T use ear candles. There is no evidence that they remove impacted cerumen, and candling can cause serious damage to the ear canal and eardrum.

*DO seek medical evaluation if you have symptoms of hearing loss, ear fullness, and ear pain if you are not certain that they are from cerumen.

*DO ask your provider about ways that you can treat your cerumen impaction at home. You may have certain medical or ear conditions that may make some options unsafe.

*DO seek medical attention with ear pain, drainage, or bleeding. These are not symptoms of cerumen impaction and need further evaluation.

The update is endorsed by American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American Geriatric Society (AGS), American Neurotology Society (ANS), American Otological Society (AOS), American Society of Geriatric Otolaryngology (ASGO), and Society of Otorhinolaryngology and Head-Neck Nurses (SOHN). Additionally, it is supported by American Speech-Language-Hearing Association (ASHA).

The guideline authors are: Seth R. Schwartz, MD, MPH; Anthony E. Magit, MD, MPH; Richard M. Rosenfeld, MD, MPH; Bopanna B. Ballachanda, PhD; Jesse M. Hackell, MD; Helene J. Krouse, PhD, RN; Claire M. Lawlor, MD; Kenneth Lin, MD, MPH; Kourosh Parham, MD, PhD; David R. Stutz, MD; Sandy Walsh; Erika A. Woodson, MD; Ken Yanagisawa, MD; and Eugene R. Cunningham Jr, MS.

Source: AAO-HNSF
Image credit: American Academy Of Otolaryngology