Cerumen impaction
Formal Definition
Accumulation of earwax (cerumen) in the external auditory canal causing complete or near-complete occlusion; a common, often overlooked cause of conductive hearing loss, tinnitus, ear fullness, and occasionally vertigo or cough (auricular branch of vagus nerve stimulation); treated by irrigation, manual removal, or ceruminolytic drops.
How It's Used on the Ward
"Impacted wax" or "needs an ear flush" — the underappreciated cause of hearing complaints in elderly patients that is instantly reversible.
Example
""82-year-old with 3 weeks of progressive hearing loss and tinnitus: otoscopy shows complete canal occlusion bilaterally with dark cerumen. Irrigated with warm water using a 30mL syringe — large plugs removed from both ears. Patient immediately heard better and reported the tinnitus resolved.""
Clinical Context
Most common cause of treatable hearing loss — frequently missed because hearing loss is attributed to aging or dementia without proper otoscopy. Treatment options: warm water irrigation (most common, avoid in perforation or prior ear surgery), manual removal with curette or suction (best in clinic with proper lighting), ceruminolytic drops (docusate, hydrogen peroxide, olive oil — soften first before irrigation). Do NOT irrigate if tympanic membrane perforation is suspected (water enters middle ear). Cough reflex during irrigation = Arnold reflex (vagal branch innervation of EAC). In elderly patients with cognitive changes, always examine the ears before diagnosing deafness.
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