El Cerumen

J Am Acad Audiol 8 : 421-430 (1997)

Cerumen Management : Professional Issues and Techniques
Phillip L. Wilson* Ross J. Roeser*t

Abstract Cerumen management is now within the scope of practice for audiologists . This paper describes the knowledge and skills required to perform cerumen management safely and effectively. Procedures for mechanical removal, suction, and irrigation are provided. Key Words: Cerumen, external ear, management

he practice of audiology requires that earcanals be unobstructed from occluding T debris, including cerumen . Moreover, for some audiologic procedures, such as electrocochleography and peritympanic hearing instrument fittings, the earcanal must be totally free from cerumen. Until recently, the general practice has been for audiologists to referpatients with excessive/impacted cerumen to their physician for removal. However, several factors have called into question the necessity of medical referral for routine cerumen removal. Among these is the significant increase in the number of audiologists in private practice where medical services are not readily available, the increased training and clinical exposure audiologists have to theearcanal, and the need for upgrading of audiologic services to hearing-impaired children in the educational system (Roeser et al, 1991). Additionally, as the average age of the population has moved into a category "at risk" for sensory hearing impairment, the high incidence of cerumen impaction in the geriatric age group has created more need for routine cerumen management. Some have argued thataudiologists do not have the training and experience to manage cerumen. However, Sharp et al (1990), using data from a survey of 289 physicians' offices,

*Callier Center for Communication Disorders/University of Texas at Dallas, Dallas, Texas ; tProgram in Communication Disorders, University of Texas at Dallas, Dallas, Texas Reprint requests : Phillip L . Wilson, Callier Center for CommunicationDisorders, 1966 Inwood Road, Dallas, TX 75235

reported that the most common "complication" in cerumen management was failure of wax removal. That is, in routine medical practice, attempts to remove cerumen are often unsuccessful. This report also found that only about half of the general practice physicians surveyed removed cerumen themselves ; the remainder "...routinely delegated the task topractice nurses, some of whom had received no instruction" (p . 1251). This report points out the commonly known fact that physicians rarely remove cerumen themselves but delegate the procedure to a staff member who has minimal training and experience . Mahoney (1993), in a study of the treatment of cerumen impaction in nursing homes, reported that there was significant difficulty in obtaining thenecessary physicians' orders that would allow the use of ceruminolytics, and that the vast majority of residents remained impacted after treatment. She noted examples of physicians who judged that the removal of cerumen did not reach a level of medical importance significant enough to justify the time commitment for treatment or even to write appropriate orders . In Mahoney's study, of the 17residents who received treatment for cerumen impaction, 12 remained 100 percent impacted, 4 were greater than 75 percent impacted, and 1 was greater than 50 percent impacted . As audiologic management of cerumen has become more commonplace, audiologists have gained increased opportunities to obtain supervised practical experience . The number of educational offerings has grown significantly, and cerumenmanagement is now an integral part of the curriculum of many graduate training programs . Consequently, along with the need for 421

Journal of the American Academy of Audiology/Volume 8, Number 6, December 1997

audiologic management of cerumen has come the opportunity for training. Audiologic procedures that require a clear earcanal include acoustic immittance, probe microphone "real-ear"...