How is mechanical cerumen impaction removal performed?

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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See the list below:

  • If space permits, use an instrument to remove the wax. A ring probe (Jobson Horne curette) may be used to scoop the wax out; experienced practitioners may prefer to use a wax hook. If the cerumen is of a harder consistency, attempt to push the wax away from the ear canal walls toward the middle and then pull it out with a crocodile forceps.

  • If the wax is occlusive, use the large-bore suction (16 or 18 ga) device to remove the wax piecemeal. As soon as the hair-bearing skin is passed, downsize the suction device to 20 ga or larger. As experience grows, one develops a sense of the depth of the tympanic membrane, which allows for safe use of the large-bore sucker closer to the tympanic membrane. But suctioning on the tympanic membrane with a large-bore risks causing a perforation and significant discomfort to the patient and should be avoided.

  • Once the cerumen is cleared, reposition the microscope. This may reveal additional cerumen or pathology, especially in the anterior recess or the attic area or if a mastoid cavity is present.

  • If the patient reports discomfort during the procedure, postpone the cerumen removal for 2 or more weeks and encourage the patient to instill ear drops such as sodium bicarbonate (5%) ear drops twice daily. Such drops soften the cerumen and make it easier to remove.

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