What are pearls 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

Try to stick to the anterior wall while clearing the canal. At the anterior wall, the angle with the tympanic membrane is more acute, and the transition to the tympanic membrane is less likely to be missed.

Ask the patient to report pain, as this is a safety net. Pain is likely due to trauma to the ear canal skin. However, touching the malleus can cause pain and is to be avoided. A very stoic patient may try to grin and bear the pain when the malleus is accidentally touched; if he or she does so, this warning sign may be missed.

Do not hesitate to postpone the cerumen removal for 2 weeks, as pain and time can be saved by softening the cerumen with drops first. Drops can be selected at the clinician’s individual preference, as reviews have failed to demonstrate significant differences between various drops. [5, 6, 7, 8] In 2009, a review of completed trials also failed to demonstrate a significant difference between using water or commercially available drops. [5]

Take special care with pediatric patients. Carefully explaining the procedure, allowing the child to touch the suction device, and introducing suction into the ear canal slowly may help children as young as 4 years to tolerate a microsuction session. However, most children only tolerate this procedure at age 8 years or older. Using a Jobson Horne probe or a ring curette may be a viable alternative in pediatric patients who do not tolerate microsuction.

Adjust to the individual patient’s needs. Meticulous cleaning is required in patients with otitis externa, but less so if they are having a mold made for a hearing aid. However, for patients who simply present with excessive wax buildup, the clinician only needs to remove most of the cerumen, and the rest can be cleared with weekly olive oil drops.

If visual inspection reveals a foreign body instead of or in addition to cerumen, removal of the foreign body may require different techniques. See Medscape Reference article Ear Foreign Body Removal Procedures for more information.

A 0-degree rigid endoscope may be quicker and easier to access than a microscope when visualizing the cerumen, ear canal, and tympanic membrane. [9]

Some cases are better dealt with in theatre under general anesthetic and this option should be discussed as part of informed consent


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