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Int J Pediatr Otorhinolaryngol 2019 Feb 5;120:73-77. Epub 2019 Feb 5.

Division of Otolaryngology, Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA. Electronic address:

Introduction: There is increasing concern regarding the risks associated with the use of general anesthesia in pediatric patients. Many otolaryngologic procedures performed under general anesthesia can also be performed in clinic. We hypothesize that anxiolytics can aid in performing common procedures in clinic thus avoiding the need to undergo general anesthesia in the OR. Read More

Am Fam Physician 2018 Oct;98(8):525-529

University of Florida, Gainesville, FL, USA.

Cerumen production is a normal and protective process for the ear canal. However, cerumen should be removed when it causes symptoms (e.g. Read More

J Laryngol Otol 2018 Sep 13;132(9):840-841. Epub 2018 Aug 13.

Department of Otolaryngology,Morriston Hospital,Swansea,Wales,UK.

Background: External auditory canal exostoses are known to occur in patients who engage in cold-water sports. Although the majority of patients with exostosis remain asymptomatic, larger lesions can cause wax impaction, conductive hearing loss and predispose to recurrent otitis externa.

Objective: A novel technique is described of using a piezo saw to excise exostoses that are symptomatic. Read More

BMC Ear Nose Throat Disord 2017 2;17. Epub 2017 Jun 2.

Eosera Inc., 1200 South Freeway Suite 132, Fort Worth, TX 76104 USA.

Background: This open-label study evaluated the safety and efficacy of a novel product for the removal of impacted cerumen in adult patients.

Methods: This was a prospective, single-center, single-arm, self-controlled clinical trial conducted in a community general practice setting. The novel product contains glycolic acid in an otologically-acceptable buffer containing sodium bicarbonate and glycerin and other buffering agents. Read More

Otolaryngol Head Neck Surg 2017 01;156(1_suppl):S1-S29

14 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA.

Objective This update of the 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidence-based 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. Read More

Int J Pediatr Otorhinolaryngol 2016 Aug 20;87:55-60. Epub 2016 May 20.

Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Objectives: Under physiological conditions, cerumen (Ce) is regularly extruded from the ear canal by a self-cleaning mechanism. Failure of this mechanism leads to excessive accumulation or impaction of Ce. Limited data are available concerning the prevalence of cerumen in healthy and sick infants and children. Read More

Geriatr Gerontol Int 2016 Mar 28;16(3):392-5. Epub 2015 May 28.

Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Japan.

Aim: Hearing loss is a risk factor for the progression of dementia. Cognitive improvement is occasionally found after removal of cerumen impaction. Because patients with dementia do not usually complain about cerumen impaction, detection methods are important. Read More

Geriatr Gerontol Int 2014 Apr;14 Suppl 2:56-61

Department of Otorhinolaryngology, National Institute for Longevity Science, Obu, Japan.

Aim: To assess the effect of cerumen impaction and its removal on hearing ability and cognitive function in elderly patients with memory disorders in Japan.

Methods: Pure tone audiometry (PTA) and the Mini-Mental State Examination (MMSE) were administered to participants before and after cerumen removal. Participants who had cerumen impaction in the better-hearing ear comprised the case group; the control group consisted of participants who either did not have cerumen impaction or had it in the worse hearing ear. Read More

Vestn Otorinolaringol 2013 (4):67-71

The problems of diagnostics, treatment and prophylaxis of inflammatory diseases of the external ear remain a challenge for practical otorhinolaryngology. The number of patients presenting with this pathology is still very high despite the availability ofa great variety of pharmacological products for their management. The problem of external otitis arises from its high incidence in conjunction with the poor effectiveness of various medicamental and non-medicamental therapeutic modalities for its treatment. Read More

Ear Nose Throat J 2012 Mar;91(3):E25-8

Ear Research Foundation, 1901 Floyd St., Sarasota, FL 34239, USA.

We conducted a prospective crossover study to assess the safety and efficacy of 70% isopropyl alcohol delivered from a squeezable bottle with a specially designed tip as a weekly irrigant to reduce cerumen accumulation. Twenty patients were divided into 2 groups of 10 (20 ears in each group). The patients in group 1 instilled 70% isopropyl alcohol once a week for 2 months; this was followed by 2 months of no ear cleaning. Read More

Arch Gerontol Geriatr 2011 Mar-Apr;52(2):228-32. Epub 2010 Apr 24.

Department of Otolaryngology, Head and Neck Surgery, The Edith Wolfson Medical Center, P.O. Box 5, 58100 Holon, Israel.

Cerumen impaction may affect hearing and decrease hearing acuity, thus decreasing cognitive functions among the elderly. The objective of this study was to compare the safety and the efficacy of three cerumenolytic agents and to assess the effect of cerumen removal on cognition. Thirty eight elderly subjects (mean age: 78 years, total 76 ears) were treated with either Auro®, Cerumol® or the newer CleanEars®, and the change in the degree of ear canal occlusion was examined after a week. Read More

East Afr J Public Health 2009 Apr;6(1):43-6

Department of ORL, Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria.

Unlabelled: Wax removal compromises the integrity of the ear's defenses. It is a leading cause of otitis externa, Otomycosis and impaired hearing. Aims of the study are to assess the knowledge and implication of self ear cleaning among black Africans. Read More

HNO 2009 Jul;57(7):713-8

Institut für Allgemeinmedizin, OE5440, Medizinische Hochschule Hannover, Hannover, Germany.

Background: Cerumen impaction is known as a frequent problem both in general practice as well as in community based ENT surgeries. The aim of the present review was to describe the frequency and types of complications due to different methods of ear wax removal.

Methods: A systematic review of the literature was carried out (Pubmed, Cochrane, Scopus) and data from the arbitration board for medical liability were evaluated. Read More

Otolaryngol Head Neck Surg 2008 Sep;139(3 Suppl 2):S1-S21

Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical School, Dallas, TX 75390, USA.

Objective: This guideline provides evidence-based recommendations on managing cerumen impaction, defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. We recognize that the term "impaction" suggests that the ear canal is completely obstructed with cerumen and that our definition of cerumen impaction does not require a complete obstruction. However, cerumen impaction is the preferred term since it is consistently used in clinical practice and in the published literature to describe symptomatic cerumen or cerumen that prevents assessment of the ear. Read More

Am Fam Physician 2007 May;75(10):1523-8

Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia 22908, USA.

Cerumen is a naturally occurring, normally extruded product of the external auditory canal. It is usually asymptomatic, but when it becomes impacted it can cause complications such as hearing loss, pain, or dizziness. It also can interfere with examination of the tympanic membrane. Read More

J Am Med Dir Assoc 2002 May-Jun;3(3):136-9

William Beaumont Hospital, Royal Oak, Michigan, USA.

Objective: This investigation was performed to study the prevalence of cerumen impaction and evaluate its impact on hearing and cognition in elderly patients admitted to a skilled nursing facility (SNF).

Design: Prospective clinical trial using a pretest-posttest design.

Setting: A 160-bed skilled nursing facility. Read More

Ann Trop Paediatr 2003 Jun;23(2):121-8

Institute of Child Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria.

The aim of this study was to determine whether children in whom impacted cerumen had been removed were at greater risk of hearing impairment than those without a history of impacted cerumen. A retrospective study was conducted in 113 subjects and their pair-matched controls taken from a population of 359 randomly selected school entrants who received otoscopic, audiometric and tympanometric evaluations. It was found that children from whom impacted cerumen had been removed were more likely to have hearing loss (p = 0. Read More

Otol Neurotol 2001 Nov;22(6):715-22

Department of Biosciences and Department of Medicine, Medical College of Ohio at Toledo, Toledo, Ohio, U.S.A.

Objective: To assess the chemical composition of cerumen by flash pyrolysis-gas chromatography/mass spectrometry.

Study Design: Collected earwax specimens were fractionated into residue and supernatant by means of deoxycholate. This natural bile acid produces significantly better disintegration of earwax in vitro than do presently available ceruminolytic preparations, and also has demonstrated excellent clinical results in vivo to date. Read More

Geriatrics 2000 Jan;55(1):80, 83-6

Cedars-Sinai Medical Towers, Los Angeles, CA, USA.

Cerumen removal in older patients can prevent serious social withdrawal due to hearing loss or infection due to untreated impaction. The recommended procedure calls for taking a careful history, examining the patient for prior pathology, and using sterile instruments, good lighting, and accepted methods of cerumen removal. Knowing when to stop irrigation and to use ceruminolytic drops or refer to a specialist is key to maximizing patient comfort and minimizing complications. Read More

J La State Med Soc 1997 Oct;149(10):358-62

Tulane University Medical Center, Department of Otolaryngolgoy-Head and Neck Surgery, New Orleans, La., USA.

Cerumen impaction represents the most common otologic problem encountered by physicians. It can affect up to 6% of the general population and a much higher percentage in the mentally retarded population. Cerumen is a mixture of secretory products of two glands in the external auditory canal where it serves a protective function. Read More

J Gerontol Nurs 1995 Dec;21(12):43-5

1. Cerumen impaction is a reversible cause of conduction hearing loss in the elderly. 2. Read More

Nurse Pract 1993 Mar;18(3):29, 33-6, 39

Sparrow Hospital and Health System, Lansing, Mich.

A cerumen plug in the external auditory canal can cause dizziness, pain, itching, ringing or decreased hearing. These symptoms are particularly distressing to elderly clients who may already have compromised hearing or be experiencing changes in functional ability. A cerumen plug that causes hearing impairments can retard children's educational and psychosocial development. Read More

Curr Med Res Opin 1992 ;13(1):21-5

Medical Department, Napp Laboratories Ltd., Cambridge, England.

Thirty-six patients with symptoms of impacted ear wax were recruited to an open, randomized, parallel group study of 'Audax' ear drops and 'Earex' ear drops. Patients had had their symptoms for several weeks and they were assessed on entry for the degree of impaction in each ear. After using the drops, morning and evening for 4 days, they were assessed on the fifth day for degree of impaction, ease of syringing, side-effects or discomfort, and the investigator's and patient's own global impression of efficacy of the ear drops. Read More

Am J Otol 1991 Nov;12(6):475-6

Department of Otolaryngology, University of Pittsburgh, PA.

Cerumen impaction and removal is a very common otologic problem. The perfect cerumenolytic agent has yet to be developed. After years of trying multiple different cerumenolytics without satisfaction, a stool softener, docusate sodium, has become our agent of choice. Read More

Postgrad Med 1977 Jul;62(1):207-9

The external auditory canal is self-cleaning. Excessive cerumen accumulation usually results from misguided attempts to remove wax and may go unnoticed until a hearing loss occurs. Mechanical removal of the wax or use of a ceruminolytic agent to soften it is recommended--irrigation may contaminate the middle ear space. Read More