Highlights & Basics
- Cerumen (ear wax) is a naturally occurring substance that cleans, protects, and lubricates the external auditory canal.
- Impaction is diagnosed when an accumulation of cerumen results in symptoms, such as hearing loss, or when it prevents adequate assessment of the ear canal or tympanic membrane.
- Intervention may include manual removal, irrigation, or use of cerumenolytic agents, or a combination of these modalities.
- After treatment, the clinician should re-examine the patient's ear and document the resolution of the cerumen impaction, and also inspect the previously occluded tympanic membrane.
- Young children, older patients, hearing aid users, individuals with a cognitive impairment, and those in nursing homes are at higher risk for cerumen impactions.
Quick Reference
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Citations
Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical practice guideline (update): earwax (cerumen impaction). Otolaryngol Head Neck Surg. 2017 Jan;156(1_suppl):S1-29.[Abstract][Full Text]
Roeser RJ, Ballachanda BB. Physiology, pathophysiology, and anthropology/epidemiology of human ear canal secretions. J Am Acad Audiol. 1997 Dec;8(6):391-400.[Abstract]
Horton GA, Simpson MTW, Beyea MM, et al. Cerumen management: an updated clinical review and evidence-based approach for primary care physicians. J Prim Care Community Health. 2020 Jan-Dec;11:2150132720904181.[Abstract][Full Text]
Roland PS, Eaton DA, Gross RD, et al. Randomized, placebo-controlled evaluation of Cerumenex and murine earwax removal products. Arch Otolaryngol Head Neck Surg. 2004 Oct;130(10):1175-7.[Abstract][Full Text]
Aaron K, Cooper TE, Warner L, et al. Ear drops for the removal of ear wax. Cochrane Database Syst Rev. 2018 Jul 25;(7):CD012171.[Abstract][Full Text]
1. Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical practice guideline (update): earwax (cerumen impaction). Otolaryngol Head Neck Surg. 2017 Jan;156(1_suppl):S1-29.[Abstract][Full Text]
2. Roeser RJ, Ballachanda BB. Physiology, pathophysiology, and anthropology/epidemiology of human ear canal secretions. J Am Acad Audiol. 1997 Dec;8(6):391-400.[Abstract]
3. Yoshiura K, Kinoshita A, Ishida T, et al. A SNP in the ABCC11 gene is the determinant of human earwax type. Nat Genet. 2006 Mar;38(3):324-30.[Abstract]
4. Horton GA, Simpson MTW, Beyea MM, et al. Cerumen management: an updated clinical review and evidence-based approach for primary care physicians. J Prim Care Community Health. 2020 Jan-Dec;11:2150132720904181.[Abstract][Full Text]
5. Guest JF, Greener MJ, Robinson AC, et al. Impacted cerumen: composition, production, epidemiology and management. QJM. 2004 Aug;97(8):477-88.[Abstract][Full Text]
6. Tomita H, Yamada K, Ghadami M, et al. Mapping of the wet/dry earwax locus to the pericentromeric region of chromosome 16. Lancet. 2002 Jun 8;359(9322):2000-2.[Abstract]
7. Shott SR. Down syndrome: common otolaryngologic manifestations. Am J Med Genet C Semin Med Genet. 2006 Aug 15;142C(3):131-40.[Abstract][Full Text]
8. Freeman RB. Impacted cerumen: how to safely remove earwax in an office visit. Geriatrics. 1995 Jun;50(6):52-3.[Abstract]
9. Coppin R, Wicke D, Little P. Managing earwax in primary care: efficacy of self-treatment using a bulb syringe. Br J Gen Pract. 2008 Jan;58(546):44-9.[Abstract][Full Text]
10. Coppin R, Wicke D, Little P. Randomized trial of bulb syringes for earwax: impact on health service utilization. Ann Fam Med. 2011 Mar-Apr;9(2):110-4.[Abstract][Full Text]
11. Hand C, Harvey I. The effectiveness of topical preparations for the treatment of earwax: a systematic review. Br J Gen Pract. 2004 Nov;54(508):862-7.[Abstract][Full Text]
12. Roland PS, Eaton DA, Gross RD, et al. Randomized, placebo-controlled evaluation of Cerumenex and murine earwax removal products. Arch Otolaryngol Head Neck Surg. 2004 Oct;130(10):1175-7.[Abstract][Full Text]
13. Aaron K, Cooper TE, Warner L, et al. Ear drops for the removal of ear wax. Cochrane Database Syst Rev. 2018 Jul 25;(7):CD012171.[Abstract][Full Text]
14. Rubin J, Yu VL, Kamerer DB, et al. Aural irrigation with water: a potential pathogenic mechanism for inducing malignant external otitis? Ann Otol Rhinol Laryngol. 1990 Feb;99(2 Pt 1):117-9.[Abstract]
15. Zikk D, Rapoport Y, Himelfarb MZ. Invasive external otitis after removal of impacted cerumen by irrigation. N Engl J Med. 1991 Sep 26;325(13):969-70.[Abstract]
16. Seely DR, Quigley SM, Langman AW. Ear candles - efficacy and safety. Laryngoscope. 1996 Oct;106(10):1226-9.[Abstract]
17. Food and Drug Administration. Detention without physical examination of ear candles. Center for Devices and Radiological Health. June 2013 [internet publication].[Full Text]
18. Driscoll PV, Ramachandrula A, Drezner DA, et al. Characteristics of cerumen in diabetic patients: a key to understanding malignant external otitis. Otolaryngol Head Neck Surg. 1993 Oct;109(4):676-9.[Abstract]
