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Subject: Cerumen Impaction Removal
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Cerumen curettes: metal loop type, metal spoon type, metal angulated spoon type, or plastic loop type
Metal syringe with a piston-type mechanism (plastic types are also available)
Kidney-shaped metal or plastic basin (to catch irrigation water)
Standing gooseneck lamp (to illuminate the ear canal opening)
Protective drape (to cover the patient’s neck and shoulder)
Cerumen impaction. Because of the associated morbidity (especially in relation to decreased hearing), cerumen impaction should always be corrected if 50% or greater of the ear canal is occluded, providing that the patient can hold still or is able to be held still.
Inability to cooperate, hold still, or be held still
Excessive cough reflex
Anticoagulation with warfarin (Coumadin)
Suspected tympanic membrane perforation
Otic furuncle or pustule
Inability to adequately visualize (excess inner ear hair and unusual ear canal anatomy)
Prior ruptured tympanum
History of tympanostomy tubes
Acute otitis media
Acute, chronic, or recurrent otitis externa
Recurrent or chronic otitis media
Other immunosuppressed hosts
Inability to cooperate
Bloody discharge from the ear
Recent ear pain
Failure after five irrigation attempts to remove any significant amounts of cerumen
PITFALL: Using water that is too warm or too cold increases the risk of stimulation of the vestibular reflex and associated nystagmus and nausea.
Perforated tympanic membrane (1 in 1,000 incidence)
Minor bleeding from the ear canal
Ear canal laceration
Malignant external otitis (in diabetics)
Perforated tympanic membrane
Otoscopes, ear curettes, emesis or ear basins, gooseneck lamps, and ear syringes can be obtained from medical supply houses.
Cerumen-softening agents such as mineral oil, triethanolamine (Cerumenex), carbamide peroxide (Debrox), or cresyl acetate (Cresylate) may be obtained from pharmacies.