MANAGEMENT OF CLIENTS WITH

DISORDERS OF THE EARCERUMEN

IMPACTION

PRESENTER:M.B.MULINDA
LUSAKA SCHOOL OF NURSING
INTRODUCTION

 Cerumen is a yellowish waxy substance

secreted in the ear canal.
 it is produced in the outer third of the
cartilaginous portion of the human ear canal.
 It is a mixture of viscous secretions from
sebaceous gland and less viscous ones from
modified apocrine sweat glands.
 It helps in cleaning and lubricating the ear canal
and it also protects it from bacterial, insects and
water.
 Cerumen, is normally expelled from the ear canal
by a self-cleaning mechanism assisted by jaw
movement.
 Occasionally this mechanism fails, and
accumulation of cerumen can lead to ear
problems
 Excess or impacted cerumen can press against
the eardrum and occlude the external auditory
canal and hinder hearing.
DEFINITION OF WAX IMPACTION

It is an accumulation of cerumen that

causes symptoms, prevents a needed
assessment of the ear canal/tympanic
membrane or audiovestibular system, or
both.
 PROBLEMS OF WAX IMPACTION

 Can prevent diagnostic assessment by

preventing complete examination of the
external auditory canal and/or tympanic
membrane or by interfering with diagnostic
assessment.
PREDISPOSING FACTORS
 Advanced age
 Conditions that produce too much
cerumen, such as keratosis and other skin
diseases
 Narrow or abnormally shaped ear canals
 Use of a hearing aid
 Incorrect use of cotton swabs, or using
needles, hair pins, or other objects to clean
the ears
 SIGNS AND SYMPTOMS

 Hearing loss
 sensation of fullness
 dizziness
 Tinnitus
 Itching
 Otalgia,
 Discharge
 Odor
 Cough.
DIAGNOSIS/EVALUATION

 Targeted history
 Physical examination

 Otoscopy

 Binocular microscopy

 Audiologic evaluation
TREATMENT/MANAGEMENT
 Watchful waiting/observation

 Education/information

 Cerumenolytic agents

 Ear canal irrigation

 Manual removal other than irrigation

(curette, probe, forceps, suction, hook)
 Cotton-tip swabs (not recommended)
MANAGEMENT OF CERUMEN IMPACTION
MANUAL REMOVAL
 Manual removal involves the use of a metal or
plastic loop or spoon.
 Manual removal does not expose the ear canal to
moisture and, therefore, may lessen the risk of
infection.
 To minimize the risk of trauma to the external
auditory canal or tympanic membrane, a
cooperative patient and more clinical skill than
other methods are required.
MANUAL REMOVAL

 quicker,
 allows direct visualization of the external
auditory canal
 Manual removal requires adequate illumination
visualization, and instrumentation.
 Examination of the ear throughout the process
can determine when removal of the cerumen
impaction is complete
IRRIGATION
 Irrigation may be attempted alone or with a
ceruminolytic pretreatment.
 different sizes of syringes are used.
 The risk of tympanic membrane perforation
can be lessened by using an ear irrigator tip
which keeps water from hitting the eardrum
and eliminates pressure buildup.
 Regardless of the system, the irrigant should
be at body temperature to prevent a caloric-
reflex response.
METHOD
 Assemble equipment.ie.
Syringe,basin,otoscope and towel
 Warm tap water to body temperature

 Fill a syringe with warm water

 Position the client comfortably

 Place a towel around the neck of the client

 Place a basin under the ear to be irrigated

 Check the location of the impacted cerumen

using an otoscope.
 Ensure the ear is free from Otitis media as well
as any perforation of ear drum.
 Place the tip of the syringe at an angle so that
the fluid pushes on one side and not directly on
the impaction.
 Observe the fluid returning for any wax
particles
 Continue irrigation up to 70 mls of fluid
 If no particles of wax are seen in water,wait for
10 minutes and repeat the irrigation
procedure.
 Monitor the client for signs of nausea and
dizziness.
 If the client becomes nauseated, stop the
procedure.
 If wax cannot be removed by irrigation, advise
client to apply wax softener at home for 2 days
prior to repeat of the irrigation procedure.
CERUMINOLYTICS
 There are three types of cerumen-softening
preparations:
 water-based
 oil-based
 non–water-based/non–oil-based
 Water-based and non–water-based/non–oil-
based agents increase cerumen miscibility,
whereas oil-based preparations lubricate the
wax.
 Water-based preparations include ; 3%
hydrogen peroxide, 2.5% acetic acid, 10%
sodium bicarbonate, and water or saline.
 Non–water-based/non–oil-based example is
Carbamide peroxide (Debrox)
 Oil-based include Arachis oil, almond oil,
rectified camphor oil ,Olive oil, or mineral oil
PREVENTION

 counsel patients on the risks and potential

benefits of specific control measures.
 Measures that may be beneficial in reducing
cerumen impaction include;
 instilling prophylactic topical preparations,

 irrigating the ear canal,

 routine cleaning of the ear canal by a clinician.

 Choices regarding topical preparations and
devices for irrigating the ear should be
discussed with the patient
 allowing for substantial patient preference
and cost factors in determining treatment
options.
 Patients should be counseled not to insert
foreign objects, such as cotton-tip swabs or
bobby pins, into the ear canal.
 These objects can further contribute to
impacting cerumen that is already present in
the canal or even damage structures in the ear.
 Individuals who wear hearing aids are at

increased risk for developing impactions.

 Instruct client on proper care and cleaning of
these aids.
 Cerumen production is a normal physiologic
process.
 Therefore, preventive measures should be
focused towards those individuals who are at
greatest risk for developing occlusion and
those with a history of impaction.
 susceptible Individuals to cerumen impaction
include the elderly, those with narrowed or
anatomically deformed ear canals, and those
with certain dermatologic conditions.
 Hearing aid users also have a higher incidence
of impaction.