USA: Now Hear This: Be Wary of Routine Earwax Removal

ALEXANDRA, Virginia (MedPage Today), August 29, 2008: By Charles Bankhead, Staff Writer, MedPage Today Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston. Because cerumen has both cleansing and protective functions, it should not be routinely removed by patients or clinicians, according to clinical guidelines issued by otolaryngologists. They were published as a supplement to the September issue of Otolaryngology -- Head and Neck Surgery by the American Academy of Otolaryngology -- Head and Neck Surgery Foundation. The guidelines warned particularly of the use of cotton swabs, jet irrigation devices designed for oral use, and ear candling. In the case of cerumen impaction, the wax should be cleared by use of dissolving agents, irrigation, and manual removal with suction devices or other special instruments, the guidelines said. "The complications from cerumen impaction can be painful and ongoing, including infections and hearing loss," said Peter Roland, M.D., of the University of Texas Southwestern Medical Center in Dallas, who chaired the guideline panel. "It is hoped that these guidelines will give clinicians the tools they need to spot an issue early and avoid serious outcomes." From its headquarters here, the organization distributed background information noting that an estimated 12 million Americans seek medical care for cerumen impaction each year, leading to eight million cerumen removal procedures. Cerumen impaction affects about 10% of children, 5% of adults, and more than a third of older patients and those with cognitive impairment. The term "earwax" is something of a misnomer, as cerumen is a water-soluble mixture of ear secretions, hair, and dead skin. Excess cerumen normally migrates from the ear canal, assisted by jaw motion, such as chewing. As it migrates from the ear canal, cerumen carries with it dirt, dust, and other small particulate matter. According to the academy, cerumen impaction occurs when the accumulation of earwax causes symptoms (such as pain, odor, discharge, or hearing loss) or interferes with assessment of the ear. Reversible hearing loss can occur when cerumen fills 80% or more of the ear canal diameter. "Unfortunately, many people feel the need to manually remove cerumen from the ears," said Dr. Roland. "This can result in further impaction and other complications to the ear canal." Recommendations and advice included in the guideline include: * Patient education about the benefits of cerumen. * Examination of all patients with hearing aids for impaction, which can cause feedback, reduce sound intensity, and damage the device. * Avoidance of inappropriate or potentially harmful interventions and instruments to remove cerumen. * Annual or semiannual evaluation of patients at high risk for cerumen impaction, such as those with hearing aids. Dr. Roland disclosed that he has consulted for Alcon Labs, MedEl Corp., Advanced Bionics, and Cochlear Corp., and served as a speaker for GlaxoSmithKline and Alcon Labs. Primary source: Otolaryngology -- Head and Neck Surgery Source reference: Roland PS, et al "Clinical practice guideline: cerumen impaction" Otolaryngol Head Neck Surg 2008; 139: S1-S21. © 2004-2008 MedPage Today, LLC.