Annals of Long Term Care

Cerumen is an amalgam of secretions from the cerumenous and sebaceous glands that line the lateral aspect of the external ear canal, and shed epithelial remnants and occasional extraneous material that finds its way into the external auditory canal. Although present in all age groups, cerumen may become particularly problematic in the elderly population and those residing in LTC facilities; impacted cerumen may lead to both worsening of an existing hearing deficit and unexpected cognitive and behavioral irregularities. Cerumen provides a number of vital services that contribute to the overall health of the external ear, yet removal is often required to assure proper examination prior to planned hearing testing, and to help in hearing aid performance. A number of techniques may be utilized to remove cerumen, and preference should depend upon a caregiver’s expertise, as well as a patient’s tolerance and receptivity to the approach under consideration. Annals of Long-Term Care: Clinical Care and Aging 2010;18[7]:39-42)

The Department of Health and Human Services’ Administration on Aging predicts that by 2030, our aging (≥ 65 yr) population will number approximately 71.5 million, twice the number counted for the year 2000. The presence of cerumen or ear wax is one of the more common ear-related issues that can negatively impact an aging population. Although present in all age groups, those advanced in years are clearly more vulnerable to a number of attendant problems associated with the presence of impacted cerumen in the external auditory canal. Residents of long-term care (LTC) facilities are particularly disadvantaged when impacted cerumen contributes to compromised hearing in those patients already suffering from chronic illness, psychiatric disorders, or social isolation.¹

Although cerumen is generally considered beneficial for the overall health of the ear, removal must be entertained should the need arise to obtain adequate visualization of ear structures in preparation for planned hearing testing, or as a routine procedure to help assure proper hearing aid function. The potential for complications resulting from routine ear cleaning should reinforce the need for caution during cerumen extraction, especially in patients with lowered tolerance levels, states of confusion, increased excitability, and compromised immune status. Removal is not always uneventful, as mishaps may occur resulting in canal trauma, itching, infection, vertigo, pain, and perforation of the tympanic membrane. The frequent use of anticoagulants in this patient population may also elevate the risk of bleeding from inadvertent trauma to either the canal or tympanic membrane.

Although the terms cerumen and wax are often used interchangeably, cerumen constitutes a combination of secretions from both the cerumenous and sebaceous glands that line the lateral extent of the external auditory canal. Cerumenous glands are modified apocrine glands that function in concert with sebaceous glands to release a wide array of products that include long-chain fatty acids, alcohols, squalene, long-chained hydrocarbons, and cholesterol precursors,² which evidently provide lubrication to the ear canal and safeguard the canal’s cutaneous surface against potential undesirable consequences of exposure to water. The term ear wax, on the other hand, actually represents a variable admixture of cerumen together with contributions from the canal skin that include spent skin and hair and the occasional presence of extraneous items such as cotton fibers, airborne debris, and hair dyes and sprays, just to name a few.