Cerumen impaction is a buildup of earwax that blocks the ear canal or causes symptoms. It is common in older adults, hearing aid users and people who use cotton swabs, which push wax deeper.
Key symptoms
- Muffled hearing or ear fullness
- Ear itch or mild discomfort
- Ringing in the ear (tinnitus)
- Cough or dizziness in some patients
- Hearing aid whistling or poor fit
What you find on exam
- Otoscopy: wax blocking the view of the eardrum
- Look for canal skin damage or infection
- Check the eardrum after removal
- Tuning fork tests for conductive hearing loss
Tests
- Diagnosis is by otoscopy
- Recheck hearing after wax removal
- Audiogram if hearing loss remains
Treatment basics
- Treat only if there are symptoms or the eardrum must be seen
- Softening drops: water, saline, carbamide peroxide or mineral oil
- Irrigation with body-temperature water
- Manual removal with a curette or suction under direct view
- No irrigation if perforation, ear tubes, or diabetes or weak immunity
Red flags
- Ear pain, bleeding or sudden hearing loss after removal
- Vertigo during irrigation
- Ear canal infection in a patient with diabetes or weak immunity (risk of malignant otitis externa)
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.