What are the preparation steps in cerumen impaction removal?

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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Answer

Answer

See the list below:

  • Assemble and prepare all necessary equipment.

  • Take time to explain the procedure to the patient and obtain consent.

  • Connect suction tip and turn on the suction machine and microscope light.

  • Position the patient’s head facing away from the operator, the neck flexed laterally and the shoulder pulled down.

  • Examine the pinna, outer portions of the external canal, and the adjacent scalp for any evidence of previous surgery incision scars, signs of infection, or discharge.

  • Inspect the outer ear canal opening, using the appropriate aural speculum, as shown below:
View through an aural speculum. View through an aural speculum.

See the list below:

  • The speculum should be the largest size that fits. It should be placed deep enough to clear the hair-bearing skin but not deeper, as unnecessary pain may result.
  • The speculum should be held with the first and second fingers. Use the other fingers to retract the pinna up and backward in an adult (retract the pinna up and downward in a child).
  • Assess the cerumen. Gently probe with a blunt instrument such as Jobson Horne curette to determine whether the cerumen is soft, hard, or bony hard.

  • Assess whether tympanic membrane is visible. Look for any air spaces around the cerumen.

  • Before beginning the cerumen removal, ensure that the microscope and operator are optimally positioned. The microscope should be positioned to provide the optimal view of the ear canal, and the operator should be sitting comfortably and with a straight back.


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