Cerumen Accumulation

Geriatric Essentials

• Cerumen accumulation is most common among the elderly and can cause hearing loss and tinnitus.

Cerumen protects the external auditory canal from infection, trauma, and water damage. Cerumen accumulation is most common among the elderly. When cerumen obstructs the external auditory canal or touches the tympanic membrane, it can cause tinnitus, a sensation of aural fullness, and hearing loss. Cerumen accumulation may also decrease hearing, aggravate a preexisting hearing loss, and interfere with hearing aid function.

Cerumen may become rock-hard and, particularly in elderly men, may contain exfoliated hairs. Cerumen is obvious during examination and may partially or completely obstruct the canal. Because the glands that produce cerumen are located in the lateral third of the canal, obstruction extending to the medial portion suggests that the patient has used an instrument (eg, cotton-tipped applicator, bobby pin, paper clip, a finger, a washcloth) to force the cerumen medially.

Treatment

Asymptomatic cerumen accumulation need not be removed. Indications for removal include tinnitus, sensation of aural fullness, hearing loss, or interference with hearing aid function.

Patients with recurring cerumen obstructions and an intact tympanic membrane can apply 2 to 3 drops of baby oil, mineral oil, or an OTC preparation (eg, triethanolamine polypeptide oleate) once or twice weekly (more frequently if necessary) to thin cerumen and allow it to flow out of the canal more readily.

Patients with an accumulation can apply 2 to 3 drops of an OTC dilute hydrogen peroxide solution, which may atraumatically flush the cerumen from the canal to the external meatus, where it may be wiped away with a washcloth.

If self-treatment is ineffective, cerumen should be removed as gently as possible. For atraumatic removal of hard accumulations, daily application of 2 to 3 drops of mineral oil for several days to a week may prevent injury to the external auditory canal during removal. If the accumulation is not hard and if visualization is good, a cerumen spoon and an aural speculum can be used. Alternatively, the canal can be gently irrigated with warm, soapy water; however, irrigation is contraindicated if the tympanic membrane is perforated, because an infection may result. Also, irrigation may perforate the tympanic membrane if done too vigorously or if the tympanic membrane has been previously damaged. Gently directing the water along the canal wall, not at the tympanic membrane, can reduce the risk of perforation. A commercially available 50-mL syringe can be used under low pressure. Syringes that contain less volume should not be used because they may generate high pressures.

This topic was last updated June 2006.