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ear wax removal
Indications:
- symptomatic cerumen impactation
- need to visualize obscured tympanic membrane
Contraindications:
- ear lavage
a) patients who cannot cooperate or maintain head in an immobile position
b) otitis externa
c) suspected perforation of the tympanic membrane
Procedure:
1) pretreatment to loosen ear wax
a) Cerumenex
b) docusate Na+ (Colace) liquid 1 mL, drain after 15 minutes
c) carbamide peroxide (Debrox) 5-10 drops BID for 4 days; allow to remain in ear for 15 minutes
2) irrigation solution (water) should be body temperature to avoid the vestibular reflex, resulting in vertigo, nausea & vomiting
3) the stream should NOT be aimed directly at the tympanic membrane
4) pretreatment with Cerumenex may be indicated
Instrument removal technique:
1) blunt ear curette (Buck) size 0 or 00
2) wire curette (cerumen spoon)
3) otoscope
4) suction device
Complications:
- malignant otitis media due to Pseudomonas aeruginosa in patients with diabetes mellitus
Notes:
- lack of evidence supporting candling [5]
Related
cerumen
triethanolamine polypeptide oleate-condensate (Cerumenex)
General
clinical procedure
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Prescriber's Letter 7(11):63 2000
- Prescriber's Letter 15(11): 2008
Earwax Removal
Detail-Document#: 241121
(subscription needed) http://www.prescribersletter.com
- Coppin R et al
Randomized trial of bulb syringes for earwax: Impact on
health service utilization
http://www.annfammed.org/cgi/reprint/9/2/110
- NEJM Knowledge+