Consultants Forum

Cerumen Impaction: Effects and Removal

Accumulating earwax and resulting cerumen impaction can present clinically important problems in the elderly, including hearing loss and altered ear temperature measurements. Yet the condition is very simple to diagnose, and impaction removal is safe, but not without risk.

Those were the major points in two articles in the December 1995 issue of the Journal of Gerontological Nursing.^1,2 The article explores special problems with cerumen impaction in the elderly, techniques and cautions about removal, and effects of impaction on ear thermometers.

Age-Related Changes and Risk Factors

Meador² described these age-related changes in cerumen physiology:

• Atrophy of cerumen glands
• Reduction in number of cerumen glands
• Drying of the cerumen
• Decreased function of the cilia

As a result, cerumen can build up in the ear canal and become oxidized from its normal honey color to a dark brown. The external ear may become dry and itchy. Cerumen impaction then decreases sound passage through the canal, affecting a person's ability to hear and communicate.¹

Several factors increase the odds of cerumen impaction:

• Numerous ear canal hairs
• Hearing aids
• Bony growths secondary to osteophyte or osteoma
• Histories of repeated cerumen impactions

Simple otoscopic examination provides diagnosis for cerumen impaction.¹

Removing Cerumen Impactions

Meador notes that removing cerumen impactions is generally accomplished by a physician or a nurse. Possible hazards include damage to the external auditory meatus from scratching the ear canal; acute otitis externa from improperly drying the ear or not reacidifying the canal; tympanic membrane perforation; otitis media if the eardrum has been previously perforated; and nausea, vertigo, or vomiting if the irrigating fluid is too hot or too cold.¹

General treatment approaches include irrigations, physical removal, and use of cerumenolytic agents. For patients with perforated tympanic membranes, otitis externa, myringotomy tubes, or a mastoid cavity, irrigations are contraindicated, and a specialist should perform the removal.¹

Meador advises using cerumenolytic agents primarily when aural lavage is difficult because of a high keratin content in the cerumen. Products such as Debrox or Cerumenex may be used; less expensive alternatives include mineral, olive, baby, and vegetable oils. She notes that allergic reactions have occurred when Cerumenex is used for longer than 24 hours.¹

The curette method is an effective way of removing the impaction; however, the patient's head should be immobilized so that quick movements will not result in ear damage. An otoscope with an operating head is used to examine the ear canal at all times during the procedure.¹

Aural lavage is the easiest and most common way to perform method to remove cerumen impactions. Fluids should always be at body temperature. Otologic syringes (20 to 50 mL) are equipped with an Angiocath or Jelco catheter rather than a needle. Dental irrigation devices can be used in the elderly; the pulsating stream of water can break up the cerumen plug, facilitating removal.¹

The final step in removing cerumen impaction is patient education. Important points include the following:

• Do not use foreign objects in the ear, including cotton-tipped applicators, bobby pins, or paper clips.
• Ears should be cleaned using a washcloth wrapped around a finger.
• Cerumenolytic agents may be used, but the softened cerumen still must be removed physically.
• A health care professional should be contacted in the event of ringing, crackling sounds, or decrease in hearing.¹

Effects on Ear Temperature Measurement

Hasel and Erickson² studied the effects of cerumen impactions on infrared ear temperature measurements in 14 elderly nursing home residents who had impactions in only one ear. They found that the average temperature reading was lowered by 0.24 ° ± 0.47 °F, with individual differences of -0.9 ° to +0.4 °F. Six of the residents had temperatures lowered 0.5 °F or more.²

The authors conclude: "The advantage of removing impacted cerumen before making infrared ear temperature measurements may be offset by the time and inconvenience of the irrigation procedure. Improved hearing may be a more important outcome of cerumen removal, with secondary benefit for temperature measurement."

L. Michael Posey
Academics Editor

References

1. Meador JA. Cerumen impaction in the elderly. J Gerontologic Nurs 1995; 21(12): 43-5.

2. Hasel KL, Erickson RS. Effect of cerumen on infrared ear temperature measurement. J Gerontologic Nurs 1995; 21(12):6-14.

The Consultants Forum is published monthly in TCP.

The column serves as an avenue for rapid communications among consultant pharmacists concerning their consulting activities in long-term care facilities of all types. Clinical information, practice tips, and news and information are published in Consultants Forum. Contributions, always welcome, should be sent to Academics Editor L. Michael Posey, P.O. Box 6565, Athens, GA 30604; 706-613-0100, 706-613-0200 (fax), mposey@aol.com (e-mail).