Ear Wax

AAOHNS Releases New Guidelines for the Treatment of Cerumen Impaction

The American Academy of Otolaryngology—Head and Neck Surgery Foundation has issued a new set of guidelines for the management of cerumen impaction in patients older than 6 months.

The new guidelines come as an update to the 2008 cerumen impaction clinical practice guideline, providing recommendations on the management of cerumen accumulation that “causes symptoms, prevents assessment of the ear, or both.” They are based on the assessment of new evidence, including 3 new guidelines, 5 systematic reviews, and 6 randomized, controlled trials.
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Among the recommendations:

  • Clinicians should treat or refer patients with cerumen impaction (strong recommendation)
  • Clinicians should explain proper ear hygiene to prevent impaction when patients have accumulation of cerumen. (recommendation)
  • Patients with impaction should be assessed for factors that modify management, including anticoagulant therapy, immunocompromised state, diabetes mellitus, ear canal stenosis, or prior radiation therapy to the head or neck. (recommendation)
  • Cerumen accumulation should not be treated in patients who are asymptomatic. (recommendation)
  • Otoscopy should be used to detect the presence of cerumen in patients with hearing aids. (recommendation)
  • Appropriate treatments for impaction include irrigation, cerumenolytic agents, or manual removal. (recommendation)
  • If initial management is unsuccessful, patients should be referred to a specialist. (recommendation)

“The high incidence and prevalence of cerumen impaction and the diversity of interventions available make this an important condition for an up-to-date, evidence-based practice guideline,” the researchers wrote.

—Michael Potts

Reference:

Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical Practice Guideline (Update) [published online January 3, 2017]. Otolaryngol Head Neck Surg. doi: https://doi.org/10.1177/0194599816671491.