Last "Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)" Advises Against The Use of Ear Candling or Coning!
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| In the images above, it is seen that in patients who try to clean their ears with a cotton swab (or push the earwax towards the eardrum by drying it), almost the entire eardrum is covered with wax, there is only a small opening left in the membrane, and the wax is concave inwards and dry. |
Cerumen and cerumen impaction
American Academy of Otolaryngology – Head and Neck Surgery Foundation. It is published in "Otolaryngology — Head and Neck Surgery" that Revision of Clinical Practice Guideline (Update): Earwax (Cerumen Impaction). Previous guideline wa spublished at year of 2008. New revision update of guideline emphasizes that cerumen is a normally producing secretion of the externa ear canal and serves to trap external dirt and other substances. Normally, the cerumen is released from the outer ear canal and moves spontaneously out of the ear. In addition, all foreign particles and microorganisms are cleaned. If the Cerumen accumulated in the ear canal that causes blockage this suitaion is defined as "cerumen impaction". It may cause ear pain, ear pressure or fullness and conductive type hearing loss.
Treatment of cerumen impaction
Treatment of impacted cerumen is include the below:
- irrigation
- manual removal of cerumen (aspiration, curettage ...)
- using of various types of cerumenolytic agents
Patients should be instructed about normal earwax and the self-cleaning structure of the external ear. It should also be noted that attempts to clean their ears using one of their children, cotton swabs, or other objects placed inside may cause more impulse to damage the ear canal of the ear canal.
The Most Reliable Cleaning Technique for Impacted Serum, Aspiration or Curette Cleaning
In ear cleaning methods performed by squeezing water into the outer ear canal and using irrigation techniques, there is a risk of eardrum damage and perforation. In patients who have not been examined beforehand and who do not have information about the integrity of the eardrum, if pressurized water is squeezing into the outer ear canal for the purpose of cleaning earwax, the pressurized water going from the hole in the eardrum to the middle ear can cause rupture and damage to the middle ear ossicles. The safest and healthiest cleaning technique is for earwax to be aspirated by an ENT specialist. In patients who are not suitable for aspiration, if the earwax is very hard, using an earwax softener product for 5-7 days and then aspirating the wax is ideal. Even if the eardrum is intact, the technique of squeezing pressurized water into the outer ear canal may still cause perforation in the eardrum when applied incorrectly. The syringe should be held diagonally in the outer ear canal, and the water entering the ear canal should make a rolling motion and directly hit the membrane. I haven't had earwax removed with this technique in almost 20 years.
The guideline advising against the use of ear candling
The guideline advises against the use of ear candling or coning becuase of the risk of damage to the eardrum and the external ear canal. In contrast to other traumatic eardrum injuries due to the fever perforation of the cells in the eardrum perforation due to a fever injury; there is a very low chance of healing the hole in the eardrum.
Search result link where you can read articles published by Dr. Murat Enoz on this website about earwax (you can reach other articles by clicking on more posts at the end of the page.) >> https://www.ent-istanbul.com/search?q=earwax
Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) Links >> Experts Update Best Practices for Diagnosis and Treatment of Earwax ... / A link to the guideline, along with other educational materials / Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
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