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cerumen impactation (obstruction)
Etiology: (risk factors)
1) hearing aids
2) excessive ear canal hair
3) benign bony growths in the ear canal
Pathology:
- external auditory canal may be completely occluded
- conductive hearing loss
Clinical manifestations:
1) acute unilateral hearing impairment
2) gradual hearing impairment
3) dizziness
4) pain or itching
5) chronic cough
Special laboratory:
- Weber test:
- with conductive hearing loss, sound is perceived as greater in the affected ear
- Rinne test:
- generally normal because cerumen impactation is associated with mild conductive hearing loss
- ONLY when conductive hearing loss becomes moderate (not mild) does sound heard via air conduction vs bone conduction become closer to 1:1 [5]
Management:
- see ear wax removal
- peroxide-based otic (cerumenolytic) [5]
- ear irrigation* (water or saline at room temperature) [5]
- indications
- patient is symptomatic [4]
- evaluation of the tympanic membrane [1]
- manual removal with instrumentation [4]
- clinical observation
* ear irrigation is indicated only if patient is symptomatic or it is necessary to visualize tympanic membrane [1]
Notes:
- lack of evidence supporting candling [5]
Related
cerumen
ear wax removal
General
external ear disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16,
17. American College of Physicians, Philadelphia 1998, 2009,
2012, 2015
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004
- Roland PS, Smith TL, Schwartz SR et al
Clinical practice guideline: cerumen impaction.
Otolaryngol Head Neck Surg. 2008 Sep;139(3 Suppl 2):S1-S21
PMID: 18707628
- Schwartz SR, Magit AE, Rosenfeld RM
Clinical Practice Guideline (Update). Earwax (Cerumen Impaction)
Otolaryngol Head Neck Surg. 2017 Jan;156(1_suppl):S1-S29
PMID: 28045591
http://journals.sagepub.com/doi/full/10.1177/0194599816671491
- NEJM Knowledge+ Otolaryngology