Cerumen impaction: The Daily PANCE Blueprint
An 80-year-old female presents to your clinic complaining that she can’t really hear out of her right ear. On physical exam, the tympanic membrane is unable to be visualized due to the intense buildup of cerumen in the external auditory canal. Which of the following is likely not true?
A. The patient has cerumen impaction
B. There is conductive hearing loss of the right ear
C. Bone conduction is likely greater than air conduction in the right ear
D. There is lateralization to the left ear during the Weber test
E. All of the above is true
Answer and topic summary
The answer is D. There is lateralization to the left ear during the Weber test
Cerumen impaction is defined as the accumulation of ear wax 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.
|
Rinne Result |
Weber Result |
| Normal |
AC > BC in both ears |
Midline |
| Conductive hearing loss |
BC > AC in the affected ear
AC > BC in the unaffected ear |
Lateralizes to the affected ear |
| Sensorineural hearing loss |
AC > BC in both ears |
Lateralizes to unaffected ear |
| AC = air conduction, BC = bone conduction |
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