During the course of a hearing evaluation or hearing aid fitting, it is sometimes necessary to remove ear wax (cerumen) from a patient’s ears. In most instances, we are able to safely and comfortable remove the cerumen without difficulty. When it is impacted, painful, or involves any contraindications as listed below, we will refer a patient on to an ENT physician.
Before completing cerumen removal, a medical history is obtained with specific interest in any known disorders or surgeries of the ear. Cerumen management is contraindicated if any of the following conditions exist: recent otalgia, ear drainage, history of diabetes, mastoid or extensive middle ear surgery, acquired immune deficiency syndrome, and the use of anti-coagulant medications.
A thorough otoscopic examination of the external auditory canal is performed to evaluate the general appearance of both the canal tissues and the occluding cerumen. The integrity of the tympanic membrane can be verified by tympanometry, if not well visualized. If the external canal or the cerumen appears to contain blood, infectious material, or a foreign body, a referral to the referring or primary care physician is warranted. If the cerumen is extremely hard and packed, or deep in the canal and possibly against the tympanic membrane, a referral is warranted.
Assuming no contraindications are found for the removal of the cerumen, it is extracted with instrumentation and/or suction. A lighted loop or curette is used to grasp and pull moist cerumen out of the canal with suction removing any remaining debris. If the cerumen appears hard and dry, a three-day course of a wax-removal agent is recommended to soften the cerumen before removal is attempted.