Safe and Sure Cerumen Removal

January 2, 2003

Frequently, I have seen cerumen removal with water picks and syringesresult in trauma, including significant tympanic membrane perforation,and infection; thus, I no longer use these devices.

The removal of impacted cerumen is always a tedious chore. Water picks and syringes are unsatisfactory methods, and aspiration is painful, noisy, and ineffective at cleaning out the discharge from infections. Is there a simple and cost-effective way to irrigate the ear canal efficiently?

-Teddy Garcia, MD
  Orange Park, Fla

Frequently, I have seen cerumen removal with water picks and syringes result in trauma, including significant tympanic membrane perforation, and infection; thus, I no longer use these devices. Instead, I recommend the following technique, which does not traumatize the external auditory canal and does not cause discomfort. Visualize the impaction with an operating microscope while the patient is supine. Because the operating microscope affords excellent binocular vision, the cerumen can then be easily and quickly removed with a small right-angle hook or a small soft ear curette. After removal, if there is evidence of infection and debris, use a small No. 5 French suction-also under the operating microscope-to very carefully remove this debris. The latter process is often facilitated by the use of otic drops. Occasionally, I have the patient put mineral oil in the ear 1 or 2 nights before the cerumen is removed. This lubricates the ear canal and often softens the impaction.

-J. Thomas Roland, Jr, MD
  Director, Division of Otology and Neurotology
  Departments of Otolaryngology and Neurosurgery
  New York University School of Medicine
  New York