January 11, 2017
2 min read

Updated cerumen impaction guidelines warn against excessive ear cleaning

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The American Academy of Otolaryngology—Head and Neck Surgery recently updated their recommendations for the diagnosis and treatment of cerumen impaction, emphasizing that patients should avoid overcleaning their ears due to increased risk of ear canal damage, infection, and exacerbated cerumen impaction.

Additionally, the recommendations urged physicians to address the ineffectiveness and potential risks associated with ear candling/coning, a popular alternative practice for cerumen removal.

“Patients often think that they are preventing earwax from building up by cleaning out their ears with cotton swabs, paper clips, ear candles or any other number of unimaginable things that people put in their ears,” Seth R. Schwartz, MD, MPH, from the department of otolaryngology at Virginia Mason Medical Center and chair of the guideline update group, said in a press release.

“The problem is that this effort to eliminate earwax is only creating further issues because the earwax is just getting pushed down and impacted further into the ear canal. Anything that fits in the ear could cause serious harm to the ear drum and canal with the potential for temporary or even permanent damage.”

These recommendations update the 2008 guidelines and include patient perspective, tools for clinicians to treat and communicate with their patients and management options in special populations for patients at heightened risk.

“Excessive or impacted cerumen is present in 1 in 10 children, 1 in 20 adults, and more than one-third of the geriatric and developmentally delayed populations,” Schwartz and colleagues wrote. “Moreover, excessive or impacted cerumen in high-risk populations, such as the elderly and developmentally delayed, is underdiagnosed and likely undertreated.”

Following a systematic review of several databases on impacted earwax literature, the panel provided revised guidelines to assist clinicians in identifying and treating patients who may benefit from interventional methods. The review yielded new evidence from six randomized controlled trials that the panel used in combination with three new key action statements on impacted earwax management, prevention and coordination of care, including:

  • Clinicians should treat, or refer to another clinician who can treat, impacted earwax when identified;
  • Clinicians should explain appropriate ear hygiene to prevent impacted earwax when patients present with impacted earwax;
  • Clinicians should perform otoscopy to detect the presence of earwax in patients with hearing aids during a clinic visit;
  • Clinicians should recommend against ear candling, coning or treating for preventing impacted earwax;
  • Clinicians should not routinely treat earwax removal in asymptomatic patients and those whose ears can be examined adequately; and
  • Clinicians should communicate with and educate patients on healthy ear care practice.

“There is an inclination for people to want to clean their ears because they believe earwax is an indication of uncleanliness. This misinformation leads to unsafe ear health habits,” Schwartz said in the release. “This update is significant because it not only provides best practices for clinicians in managing cerumen impaction, it is a strong reminder to patients that ear health starts with them, and there are many things they should do as well as many things that they should stop doing immediately to prevent damage to their ears.”– by Kate Sherrer

Disclosure: This study was funded by AAO-HNSF. Ballachanda is a chief of audiology and a consultant for Audiology Management Group; Hackell reports holding shares at Pfizer and GlaxoSmithKline, being an expert witness and medical malpractice consultant; Krouse is a AAO-HNSF journal editor and a spouse to an AAO-HNSF board director; Sohn reports research funding; Woodson is a consultant for Oticon Medical and reports speaker honoraria for CitiGroup; and Cunningham is a salaried employee of AAO-HNSF. All other authors report no relevant financial disclosures.