Page 86 - Community pharmcy practice E-book 2025

02/11/2025, 00:10 Otic & Ophthalmic Disorders | Dermatological Disorders

Excessive or Impacted Cerumen

Cerumen is a naturally occurring substance that assists in the defence of the external ear canal (EAC); it is
recognized to clean, protect, and lubricate the EAC.
A common myth that all earwax should be removed by cleaning may lead to excessive attempts at clearing the
ear canal, with consequent damage to the EAC if done improperly.
Cerumen lubricates the canal, traps dust and foreign materials, and provides a waxy, waterproof barrier to the
entry of pathogens. Within the cerumen are various antimicrobial substances (lysozymes), and it has an acidic
pH, which helps inhibit bacterial and fungal growth.
Patients engaging in self-care should be educated on the natural defences of the ear canal. Considerations
include the protective role of cerumen, the importance of maintaining the normal pH (<6.5) of the EAC.

Symptoms

The sensations of ear fullness, dull pain, or itching may be associated with excessive or impacted cerumen.

Other common symptoms may include: discomfort, tinnitus, dizziness, vertigo, cough, hearing loss.

Treatment of Excessive or Impacted Cerumen

Non pharmacologic Therapy
Earwax should only be removed when it has migrated to the outermost portion of the EAC.

The nonpharmacologic method to eliminate cerumen is with an ear-cleaning tool, or curette, for manual
earwax removal.

The curette can be reused and is only for adult use & are marketed only to clean the entrance area of the
EAC.

Even though the ear cleaners can be inserted into the EAC, caution is indicated because of the associated
risk of trauma to the canal skin or tympanic membrane.

DO NOT
The use of cotton-tipped swabs for ear cleaning or any other product intended for insertion into the EAC
may cause increased cerumen impaction with occlusion of the canal and is not recommended in the
practice guidelines.

Pharmacologic Therapy
Cerumenolytics:
Currently the only FDA-approved nonprescription cerumenolytic (earwax-softening agent) is carbamide

peroxide 6.5% in anhydrous glycerin.
It is recommended to soften and mechanically break down excessive or impacted cerumen.

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