Cerumen impaction is a common presentation in primary care, with excessive or impacted cerumen present in one in 10 children, one in 20 adults, and more than one-third of the geriatric and developmentally-delayed populations.
Patients will often try to prevent cerumen build-up by cleaning their ears with cotton buds or by opting for ear candling. However, new guidelines from the American Academy of Otolaryngology–Head and Neck Surgery warn that patients should be advised against such practices. In the guidelines, the authors highlight a number of risks associated with ear candling in particular, including ear blockage, tympanic membrane perforation, conductive hearing loss and otitis externa. Instead, clinicians should explain proper ear hygiene to prevent cerumen impaction.
The guidelines also state that clinicians should not routinely treat cerumen in patients who are asymptomatic and whose ears can be adequately examined. When cerumen impaction is identified, it should be treated using cerumenolytic agents, irrigation, and/or manual removal requiring instrumentation.