Ear wax removal: a survey of current practice.

Sharp, J. Franklin; Wilson, Janet A.; Ross, Linda; Barr-Hamilton, R. M.

doi:10.1136/bmj.301.6763.1251

Cited by 82 publications

(118 citation statements)

References 4 publications

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“…3 Hearing loss can range from 5 to 40 dB depending on the degree of occlusion of the canal with cerumen. 9,10 While cerumen impaction may be asymptomatic in some cases, management may be necessary for diagnostic purposes so that the ear canal and/or tympanic membrane can be visualized or diagnostic assessment can be performed. 22 Multiple treatment options exist for cerumen impaction: observation, cerumenolytic agents, irrigation, and manual removal other than irrigation.…”

Section: Health Care Burdenmentioning

confidence: 99%

“…3,9,10 Presence of any of these symptoms should prompt the clinician to examine the ear canal and, if cerumen is encountered, consider the diagnosis of impacted cerumen.…”

Section: Is Removing Earwax Expensive?mentioning

confidence: 99%

“…8 Accumulation of cerumen, caused by failure of the selfcleaning mechanism, is one of the most common reasons why patients seek medical care for ear-related problems. 4,9 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. 3,10,11 About 12 million people in the United States annually seek medical care for problematic cerumen, resulting in nearly 8 million cerumen removal procedures.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)

Schwartz

Magit

Rosenfeld

et al. 2017

Otolaryngol.--head neck surg.

100

119

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Objective. This update of the 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidencebased recommendations on managing cerumen impaction. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. Changes from the prior guideline include• a consumer added to the development group;• new evidence (3 guidelines, 5 systematic reviews, and 6 randomized controlled trials); • enhanced information on patient education and counseling; • a new algorithm to clarify action statement relationships;• expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences of opinion; • an enhanced external review process to include public comment and journal peer review; and • 3 new key action statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination of care.Purpose. The primary purpose of this guideline is to help clinicians identify patients with cerumen impaction who may benefit from intervention and to promote evidence-based management. Another purpose of the guideline is to highlight needs and management options in special populations or in patients who have modifying factors. The guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction, and it applies to any setting in which cerumen impaction would be identified, monitored, or managed. The guideline does not apply to patients with cerumen impaction associated with the following conditions: dermatologic diseases of the ear canal; recurrent otitis externa; keratosis obturans; prior radiation therapy affecting the ear; previous tympanoplasty/myringoplasty, canal wall down mastoidectomy, or other surgery affecting the ear canal.Key Action Statements. The panel made a strong recommendation that clinicians should treat, or refer to a clinician who can treat, cerumen impaction, defined as an accumulation of cerumen that is associated with symptoms, prevents needed assessment of the ear, or both.The panel made the following recommendations: (1) Clinicians should explain proper ear hygiene to prevent cerumen impaction when patients have an accumulation of cerumen. (2) Clinicians should diagnose cerumen impaction when an accumulation of cerumen, as seen on otoscopy, is associated with symptoms, prevents needed assessment of the ear, or both. (3) Clinicians should assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as ≥1 of the following: anticoagulant therapy, immunocompromised state, diabetes mellitus, prior radiation therapy to the head and neck, ear canal stenosis, exostoses, and nonintact tympanic membrane. (4) Clinicians should not routinely treat cerumen in patients who are asymptomatic and whose ears can be adequately examined. (5) Clinicians s...

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Section: Health Care Burdenmentioning

confidence: 99%

“…3,9,10 Presence of any of these symptoms should prompt the clinician to examine the ear canal and, if cerumen is encountered, consider the diagnosis of impacted cerumen.…”

Section: Is Removing Earwax Expensive?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)

Schwartz

Magit

Rosenfeld

et al. 2017

Otolaryngol.--head neck surg.

100

119

View full text Add to dashboard Cite

show abstract

“…4,8 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. 3,9,10 About 12 million people seek medical care annually for problematic cerumen in the United States, resulting in nearly 8 million cerumen removal procedures.…”

Section: Introductionmentioning

confidence: 99%

Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) Executive Summary

Schwartz

Magit²,

Rosenfeld

et al. 2017

Otolaryngol.--head neck surg.

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The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the updated Clinical Practice Guideline: Earwax (Cerumen Impaction). To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations emphasize proper ear hygiene, diagnosis of cerumen impaction, factors that modify management, evaluating the need for intervention, and proper treatment. An updated guideline is needed due to new evidence (3 guidelines, 5 systematic reviews, and 6 randomized controlled trials) and the need to add statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination of care. Differences from Prior GuidelineThis clinical practice guideline is as an update, and replacement, for an earlier guideline published in 2008 by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF).1 An update was planned for 5 years after the initial publication date and was further necessitated by new primary studies and systematic reviews that might suggest a need for modifying clinically important recommendations.2 Changes in content and methodology from the prior guideline include the following: addition of a consumer advocate to the guideline update group (GUG); 3 guidelines, 5 systematic reviews, and 6 randomized controlled trials (RCTs); emphasis on patient education and counseling with new explanatory tables; expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences of opinion; enhanced external review process to include public comment and journal peer review; new algorithm to clarify decision making and action statement relationships; and 3 new key action statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination of care.

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“…11 Our fi nding that the number of irrigation procedures equates to 3.1% of the population differs from the 7% found in a Scottish primary care questionnaire survey, which estimated the number of ears rather than patients. 12 Our fi gures are based on a retrospective search of patient records, however, and relate to records of procedures carried out. As such, they are probably a more reliable fi gure on which to estimate overall workload and utilization of health care resources.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Randomized Trial of Bulb Syringes for Earwax: Impact on Health Service Utilization

Coppin¹,

Wicke²,

Little³

2011

The Annals of Family Medicine

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PURPOSE Bulb syringes can be used for the self-clearance of earwax and, in the short term, appear effective. We compared the long-term effectiveness of selfirrigation using a bulb syringe with routine care in United Kingdom (UK) family practice clinics where irrigating ears to remove wax is a common procedure. METHODSWe assessed the impact on health service utilization as a follow-up to a single-blind, randomized, controlled trial of 237 patients attending 7 UK family practice clinics with symptomatic, occluding earwax who were randomized to an intervention group (ear drops, bulb syringe, instructions on its use and re-use) or a control group (ear drops, then clinic irrigation). After 2 years, a retrospective notes search for earwax-related consultations was carried out. We used an intention-totreat analysis to assess differences in dichotomous outcomes between groups.

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Ear wax removal: a survey of current practice.

Cited by 82 publications

References 4 publications

Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)

Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)

Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) Executive Summary

Randomized Trial of Bulb Syringes for Earwax: Impact on Health Service Utilization

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