Cerumen is a protective secretion produced by the outer portion of the ear canal. In most persons, the ear canal is self-cleansing.
Recommended hygiene consists of cleaning the external opening only with a washcloth over the index finger. Cerumen impaction is most often self-induced through ill-advised cleansing attempts by entering the canal itself. It may be relieved by the patient using detergent ear drops (eg, 3% hydrogen peroxide; 6.5% carbamide peroxide) and irrigation, or by the clinician using mechanical removal, suction, or irrigation.
Irrigation is performed with water at body temperature to avoid a vestibular caloric response. The stream should be directed at the posterior ear canal wall adjacent to the cerumen plug. Irrigation should be performed only when the tympanic membrane is known to be intact.
“Cerumen impaction is a buildup of earwax that blocks the ear canal. Earwax normally cleans and protects the ear canal. When too much builds up, it can affect hearing and cause other problems.”
Use of jet irrigators (eg, WaterPik) should be avoided since they may result in tympanic membrane perforations. Following irrigation, the ear canal should be thoroughly dried (eg, by the patient using a hair blow-dryer on lowpower setting or by the clinician instilling isopropyl alcohol) to reduce the likelihood of external otitis.
Specialty referral is indicated if impaction is frequently recurrent, if it has not responded to routine measures, or if there is tympanic membrane perforation or chronic otitis media.