Cerumen Impaction in the Elderly

Cerumen Impaction in the Elderly: Risk Factors, Management & Treatment

In the United States, cerumen accumulation leads to 12 million patient visits and 8 million cerumen removal procedures annually¹,and approximately 150,000 cerumen removals weekly.² Cerumen impaction is more common in the elderly and patients with cognitive impairment. In the developmentally delayed adult population, 28% to 36% have excessive or impacted cerumen.³

What Is Cerumen?

Cerumen, also known as earwax, is made by the body in the outer ear canal as a way to protect and clean the ear. The yellowish waxy substance is a combination of lubricants and dry tissue from the body.

The cerumen has three main functions:

To lubricate the skin of the outer ear canal. This prevents itchiness and reduces the incidence of tiny cracks that could trap bacteria and allow an infection to flourish.
Cerumen also helps to maintain the acidic environment of the ear canal. This acidity kills fungi and bacteria, further shielding the ear from infection.
Finally, cerumen helps to keep the ear canal clean. Movements of the jaw propel earwax along the ear canal. As it moves from the ear’s interior toward the outer ear, the earwax sweeps up dead skin cells and tiny contaminants like dirt, dust, and dead bacteria and carries them out of the ear canal.⁴

What Is Cerumen Impaction?

Cerumen impaction is an accumulation of cerumen that causes symptoms or prevents assessment of the ear canal, tympanic membrane, or audiovestibular system; complete obstruction is not required.⁵

The diagnosis of cerumen impaction is made by direct visualization with an otoscope.⁶

Risk Factors of Cerumen Impaction

There are numerous risk factors for cerumen impaction, including the use of hearing aids and ear buds, ear canal hairs, and Bony Growths secondary to Osteophyte or Osteoma.⁷

Elderly people often experience ear wax build-up due to hearing aids use or not having their ears regularly cleaned.

Another risk factor is the repeated use of cotton swabs to clean the ear canal. Cleaning out ears with a cotton swab only allows a tiny amount of earwax to be picked up by the swab while the bulk of the wax gets compacted and jammed further into the outer ear canal, making the problem worse.⁸

Signs and Symptoms of Cerumen Impaction

Cerumen impaction leads to a variety of symptoms such as itching, pain, hearing loss, tinnitus (ringing in the ears), and chronic otitis externa (thick and dry skin building up inside the ear canal.) Otitis externa causes the ear canal to narrow (stenosis), which may affect your hearing.⁹

Vertigo is also a common symptom of cerumen impaction if the earwax pushes against the eardrum or tympanic membrane.

Lastly, dizziness can occur because the ears are integral to the body’s ability to maintain its balance. The presence of dizziness in the elderly is a strong predictor of falls, which is the leading cause of accidental death in people older than 65 years.¹⁰

Managing and Treating Cerumen Impaction

When cerumen causes symptoms or prevents necessary clinical examination, impaction should be treated. In some cases, treatment may be indicated even if the patient is not symptomatic.¹¹ There are three main options for the management and treatment of cerumen impaction:

Option	Advantages	Disadvantages/Complications
Irrigation	Effective	Doctor administered – Tympanic membrane perforation; pain; vertigo; external auditory canal trauma; otitis externa; severe audio vestibular loss
Manual removal	Effective	Skin laceration; pain; patient cooperation required
Topical preparations	Effective, but no more than saline or water	Otitis externa; allergic reactions; pain or vertigo if tympanic membrane is not intact; transient hearing loss

The use of Clinere® can also successfully resolve cerumen impaction and increase the overall health of patients.

Clinere® and Cerumen Impaction

Clinere® is a patented ear cleaning tool, similar to an ENT specialist tool. It is dual-sided with a Scoop on one end and a Honeycomb Fin on the other. It is made in the United States, with over 10 years on the market. It is portable, convenient, and easily used.

Clinere® removes dirt and ear wax that can cause infection and hearing loss, while also providing itch relief and exfoliation. It has a proven reduction in secondary ailments as a result of Cerumen Impaction including vertigo, hearing loss, tinnitus (ear ringing), and cognitive decline of patients. Clinere® can also reduce frustration, stress, depression, and social isolation as it relates to hearing impairment resulting from cerumen impaction.¹²

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