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Production of cerumen (earwax) is a normal and naturally occurring process. It protects the ear from infection and provides a barrier to insects and water. Cerumen is typically expelled from the ear canal spontaneously via natural jaw movement. However, this self-cleaning mechanism fails in certain individuals, and cerumen can become impacted. Excessive buildup of cerumen is likely underdiagnosed and undertreated. It is most often diagnosed by direct visualization by a trained clinician using an otoscope but may require more complex equipment, such as an operating microscope, for removal. This activity describes the pathophysiology of cerumen impaction, reviews the technique involved in cerumen removal, and highlights the interprofessional team's role in managing affected patients. Objectives: Assess the pathophysiology of cerumen impaction. Identify the techniques available to remove cerumen. Evaluate the complications associated with the removal of cerumen. Communicate the role of the interprofessional team in improving outcomes for patients with cerumen impactions. Access free multiple choice questions on this topic.

Production of cerumen (earwax) is a normal biological process in humans and many other mammals. Cerumen moisturizes the skin of the external auditory canal and protects it from infection, providing a barrier against the intrusion of water, foreign bodies, and even insects and other arthropods. Due to normal jaw movement, Cerumen is typically expelled from the ear canal spontaneously. However, this automatic clearing mechanism fails in specific individuals, and cerumen can become caught and impacted.[1] Cerumen impaction can occlude the external auditory canal or press against the tympanic membrane, potentially causing ear fullness, conductive hearing loss, itching, and pain. Cerumen impaction is the most common ear complaint of patients to clinicians in the United States, occurring in up to 6% of the general population, affecting 10% of children and greater than 30% of the elderly and cognitively impaired. It is often seen in patients who routinely wear hearing aids or earplugs and those with exostoses or anatomic abnormalities of the external ear canal.[1][2] Excessive buildup of cerumen is likely underdiagnosed and undertreated. In the United States, it leads to 12 million patient visits and 8 million cerumen removal procedures each year. It can interfere with tympanic membrane examination, audiometry, and hearing aid fitting. It is most often diagnosed by direct visualization by a trained clinician using an otoscope but may require more complex equipment, such as an operating microscope, for removal.[1][3]

There are several over-the-counter devices to remove cerumen that patients should be advised not to purchase. Cotton swabs are commonly used but should be avoided, as they may worsen the impaction or cause a tympanic membrane perforation. Another common home remedy is ear candling. This involves a hollow tube coated in beeswax; 1 end is inserted into the ear canal, and the other is ignited. It is falsely claimed to have a "chimney effect," created by the pull of air from the ignited candle. The United States Food and Drug Administration strongly recommends against using this device because it is not effective in scientific studies but does carry the potential for injury.[3][14]

Cerumen impaction is rarely challenging to treat but requires a coherent and cooperative patient to be successful. If the patient is unwilling or unable to participate and cooperate in treatment, removing impacted cerumen and otologic examination can be performed under general anesthesia or conscious sedation. Anesthesia is typically only necessary in the very young or in those patients whose neurocognitive and neurobehavioral status prevents safe treatment while fully awake.[16] This procedure, while straightforward, still requires the efforts of an interprofessional team, including family clinicians, otolaryngologists, and nursing staff, depending on the complexity of the specific case. Every interprofessional team member must maintain open communication with other team members and maintain accurate records of their interactions and inventions with the patient. This interprofessional approach yields optimal results with the fewest adverse events.