Cerumen Impaction Removal

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.


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. Cerumen is typically expelled from the ear canal spontaneously as a result of normal jaw movement. However, this automatic clearing mechanism fails in specific individuals, and cerumen can become caught and impacted.

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.

Excessive buildup of cerumen is likely underdiagnosed and undertreated. In the United States, it leads to 12 million patient visits and eight million cerumen removal procedures each year. It can interfere with tympanic membrane examination as well as 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.

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