Objective: To provide family physicians with a practical, evidence-based approach to managing patients with cerumen impaction. Methods: MEDLINE, The Cochrane Library, and the Turning Research Into Practice (TRIP) database were searched for English-language cerumen impaction guidelines and reviews. All such articles published between 1992 and 2018 were reviewed, with most providing level II and III evidence. Results: Cerumen impaction is a common presentation seen in primary care and cerumen removal is one of the most common otolaryngologic procedures performed in general practice. Cerumen impaction is often harmless but can be accompanied by more serious symptoms. Cerumenolytics and irrigation of the ear canal are reasonable first-line therapies and can be used in conjunction or isolation. If irrigation and cerumenolytics are contraindicated, manual removal is appropriate, but the tools necessary are not commonplace in primary care clinics and specialized training may be required to prevent adverse outcomes. Conclusion: Family physicians play a key role in the assessment and management of cerumen impaction and are well equipped to do so. Knowledge of the available techniques for cerumen removal as well as their contraindications ensures that cerumen is removed safely and effectively. When cerumen removal cannot be removed safely in a primary care setting, referral to Otolaryngology-Head and Neck Surgery is appropriate.

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Objective To provide family physicians with a practical evidence-based approach to the management of patients with sialadenitis.Sources of information MEDLINE and PubMed databases were searched for Englishlanguage research on sialadenitis and other salivary gland disorders, as well as for relevant review articles and guidelines published between 1981 and 2021.Main message Sialadenitis refers to inflammation or infection of the salivary glands and is a condition that can be caused by a broad range of processes including infectious, obstructive, and autoimmune. History and physical examination play important roles in directing management, while imaging is often useful to establish a diagnosis. Red flags such as suspected abscess formation, signs of respiratory obstruction, facial paresis, and fixation of a mass to underlying tissue should prompt urgent referral to head and neck surgery or a visit to the emergency department. ConclusionFamily physicians can play an important role in the diagnosis and management of sialadenitis. Prompt recognition and treatment of the condition can prevent the development of complications. Sialadenitis is inflammation or infection of the salivary glands that can present acutely or chronically. Sialadenitis can cause serious discomfort in everyday activities such as chewing food. There are numerous pathologies that can cause sialadenitis, which are reviewed below. Case presentationMr A., a 57-year-old driving instructor, has been bothered by a swollen, red, and tender area on his right cheek for 2 days. He rescheduled several lessons after he began to feel feverish. He noticed a foul taste while spitting out his toothpaste and has experienced pain while eating. What are the next steps in determining the cause of Mr A.'s pain? Sources of informationPubMed and MEDLINE databases were searched for English-language reviews, guidelines, and research articles published between 1981 and 2021 concerning the topic of sialadenitis.This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to https://www.cfp.ca and click on the Mainpro+ link. This article has been peer reviewed.

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