When is cerumen impaction removal indicated?

Updated: May 09, 2018
  • Author: F Carl van Wyk, MB, ChB, MRCS, FRCS(Edin); Chief Editor: Arlen D Meyers, MD, MBA  more...
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Cerumen in the external ear canal is physiological.

Cerumen, commonly known as ear wax, is a hydrophobic protective covering in the ear canal. It acts to shield the skin of the external ear canal from water damage, infection, trauma, and foreign bodies. [13, 14]

Cerumen impaction is asymptomatic but in some circumstances it requires removal when causing symptoms or to facilitate ear examination.

Indications to address the cerumen include the following: [4, 15, 16]

  • Difficulty in examining the full tympanic membrane
  • Otitis externa
  • Wax occlusion of the external ear canal
  • As part of the workup for conductive hearing loss
  • Prior to taking the impression for hearing aid fitting
  • Suspected external ear canal or middle ear cholesteatoma
  • Suspected external ear canal pathology such as squamous cell carcinoma or eczema
  • As part of the follow-up of canal wall down mastoidectomy
  • As part of grommet insertion or middle ear surgery (preoperatively, intraoperatively, or postoperatively)
  • Itchy ears
  • Reflex cough
  • Patient hearing impaired or discomfort in the ear
  • Foreign body removal, mainly in children
  • Patient request

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