Cerumen Impaction: The Daily PANCE Blueprint
A 68-year-old male presents to your clinic complaining of decreased hearing in his right ear for the past few weeks, along with a sensation of fullness. On otoscopic examination, you visualize complete occlusion of the right external auditory canal with cerumen The left ear appears normal. Which of the following is the most appropriate next step in management?
A. Reassure the patient and schedule follow-up in 3 months
B. Refer immediately to otolaryngology
C. Recommend ear candling to remove the impacted cerumen
D. Treat with cerumenolytic agents, irrigation, or manual removal with instrumentation
E. Prescribe oral antibiotics for suspected otitis externa
The answer is D. Treat with cerumenolytic agents, irrigation, or manual removal with instrumentation
Cerumen impaction is defined as the accumulation of earwax that causes symptoms or prevents providers from effectively assessing the external auditory canal or tympanic membrane. It is a common cause of hearing loss. Clinical features include hearing loss, ear fullness, itching, pain, tinnitus, and imbalance. Diagnosis is made by visualizing the impaction with an otoscope. The Rinne and Weber tests can be used as well to evaluate hearing loss (see next page). Management can include irrigation, administering cerumenolytic agents, or manual removal with instrumentation.
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint EENT ⇒ External ear (PEARLS) ⇒ Cerumen impaction