Patient handout

Cerumen (earwax) impaction

PRODUCTION

1. Your condition

This handout is for cerumen (earwax) impaction. Your care team identified this based on: conductive hearing loss / aural fullness with cerumen visible obstructing the canal on otoscopy — symptomatic cerumen impaction (aao-hns 2017 kas 2, schwartz otolaryngol hns 2017 pmid 28045591).

Other reasons your team may use this plan: otalgia, tinnitus, reflex cough (arnold-nerve), or mild vertigo attributed to obstructing wax — impaction is symptomatic (aao-hns 2017 kas 1/2 pmid 28045591); cerumen prevents a needed otoscopic / tympanometric / audiometric / pre-operative ear assessment — impaction by the prevents-assessment criterion even if asymptomatic (aao-hns 2017 kas 2 pmid 28045591); hearing-aid user — perform otoscopy at every healthcare encounter to detect occluding cerumen / aid dysfunction / feedback (aao-hns 2017 kas 6 pmid 28045591).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
otoscopic_confirmation_and_contraindication_gate_no_treatment_if_asymptomatic	—	—	—	AAO-HNS 2017 KAS 2/4 (Schwartz PMID 28045591) — treat only symptomatic/obstructing impaction; KAS 3 — capture management modifiers. Known/suspected perforation, patent tube, prior ear surgery, only-hearing ear, or active OE → NO irrigation; proceed direct to manual removal under vision (Step 4) or refer.

Plan: Symptomatic / obstructing cerumen impaction — softening → irrigation → manual-removal ladder (AAO-HNS 2017 KAS 7)

3. When to call your provider

Contact your care team if any of the following happen:

First-line management unsuccessful / recurrent / narrow-stenotic-exostotic canal → ENT / microsuction referral (KAS 10)
Hearing loss persisting after demonstrable clearance / sudden ≤72 h sensorineural pattern → route ent.sudden-sensorineural-hearing-loss.core.v1 (KAS 9)
Otorrhea / pain out of proportion / granulation in a diabetic-immunocompromised host → route ent.otitis-externa.core.v1 (necrotizing OE)
Vertigo persisting after clearance (not transient caloric) → route ent.bppv.core.v1 / vestibular workup

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Known/suspected TM perforation, patent tympanostomy (ventilation) tube, or prior ear surgery (tympanoplasty/mastoidectomy/canal-wall-down) — STRONG contraindication to irrigation (AAO-HNS 2017 KAS 3 Schwartz PMID 28045591)
Diabetes or immunocompromise with cerumen impaction (± any canal inflammation) — irrigation-associated otitis externa can seed NECROTIZING (malignant) otitis externa (AAO-HNS 2017 KAS 3 PMID 28045591)
Hearing loss persists after the canal is demonstrably clear, OR a sudden (≤72 h) loss out of proportion to the visible wax with Weber lateralising AWAY from the affected ear — the loss was NOT (just) wax (AAO-HNS 2017 KAS 9 PMID 28045591)(life-threatening)

5. Follow-up

Primary-prevention counselling (KAS 1): do NOT use cotton buds / self-instrumentation (pushes wax in, perforation risk); leave self-cleaning ears alone; appropriate control measures (periodic softening/irrigation, scheduled microsuction) for recurrent impactors and hearing-aid users; explicit advice AGAINST ear candling (KAS 8). Recurrent/narrow/exostotic-canal patients and cognitively-impaired/hearing-aid populations get a scheduled surveillance + clearance plan and ENT linkage; close-loop any routed-out audiometry/SSNHL/OE/vestibular result.

6. Sources

Guideline: AAO-HNS Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) — Schwartz et al, Otolaryngol Head Neck Surg 2017;156(1_suppl):S1-S29 (PMID 28045591); Executive Summary 2017;156(1):14-29 (PMID 28045632); Corrigendum 2017;157(3):539 (PMID 28786340); Plain Language Summary 2017;156(1):30-37 (PMID 28045640). Verified 2026-05-17 as still the current AAO-HNS authority (replaced the 2008 guideline; not superseded). Supplemented by the Cochrane "Ear drops for the removal of ear wax" review (Aaron/Burton 2018 CD012171.pub2, PMID 30043448; superseding CD004326.pub2 PMID 19160236 and CD004400 PMID 12918014), Piromchai Otol Neurotol 2020 cerumenolytic RCT (PMID 32658399), and the irrigation-complication literature (Schmiemann HNO 2009 PMID 19557323; Ogunleye Afr J Med Med Sci 2004 PMID 15490792; Thomas J Laryngol Otol 2012 PMID 22643328; Bird Aust Fam Physician 2003 PMID 12666354).