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Title: Clinical Guidelines Released for Identifying, Treating Cerumen Impaction
URL: http://www.pslgroup.com/dg/22A32E.htm
Doctor's Guide
August 29, 2008

ALEXANDRIA, Va -- August 29, 2008 -- The American Academy of Otolaryngology -- Head and Neck Surgery Foundation (AAO-HNSF) will issue the first comprehensive clinical guidelines to help healthcare practitioners identify patients with cerumen impaction.

The guidelines emphasise evidence-based management of cerumen impaction by clinicians and inform patients of the purpose of ear wax in hearing health.

"Approximately 12 million people a year in the United States seek medical care for impacted or excessive cerumen," said Richard Rosenfeld, MD, AAO-HNSF Guideline Development Task Force, Alexandria, Virginia.

"This leads to nearly 8 million cerumen removal procedures by healthcare professionals. Developing practical clinical guidelines for physicians to understand the harm versus benefit profile of the intervention was essential."

Recognising that patients may seek care from many different types of healthcare providers, the taskforce developed guidelines intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction.

Key features of the new guidelines include:
· Cerumen is a beneficial, self-cleaning agent, with protective, lubricating (emollient), and antibacterial properties.
· Clinicians should examine patients with hearing aids for cerumen impaction because it may cause feedback, reduce sound intensity, or damage the hearing aid.
· Cerumen may cause reversible hearing loss when it blocks 80% or more of the ear canal diameter.
· Appropriate options for cerumen impaction are (1) cerumenolytic agents, which include water, saline, and other agents of comparable efficacy; (2) irrigation or ear syringing, which is most effective when a cerumenolytic is instilled 15 to 30 minutes prior; and (3) manual removal with special instruments or a suction device, which is preferred for patients with narrow ear canals, eardrum perforation or tube, or immune deficiency.
· Inappropriate or harmful interventions are cotton-tipped swabs, oral jet irrigators, and ear candling.
· Clinicians should assess patients at the conclusion of in-office treatment for cerumen impaction and document resolution of the impaction.
· There are no proven ways to prevent cerumen impaction, but not inserting cotton-tipped swabs or other objects in the ear canal is strongly advised; individuals at high risk should consider seeing a clinician every 6 to 12 months for routine cleaning.

"The complications from cerumen impaction can be painful and ongoing, including infections and hearing loss," said Dr. Roland. "It is hoped that these guidelines will give clinicians the tools they need to spot an issue early and avoid serious outcomes."

SOURCE: American Academy of Otolaryngology -- Head and Neck Surgery

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