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Cerumen Impaction Guideline Near Publication

Cerumen impaction is a relatively benign condition that affects a lot of people—between 6 million and 18 million in the United States. Managing that many patients requires updated information. This information will be available when Clinical Practice Guideline: Cerumen Impaction is published early next year.

“AAO-HNSF Clinical Practice Guideline (Update): Cerumen Impaction will be presented from” 1:15 pm-2:15 pm Monday Ballroom 6C.

A Monday session will preview changes in the guideline, which include references to new literature, new action statements, and a new algorithm for the management of patients, said Seth R. Schwartz, MD, MPH, chair of the guideline update panel and moderator of the session.

“New literature in the last six or seven years sheds additional light on the topic,” said Dr. Schwartz, director of the Listen for Life Center at Virginia Mason Medical Center, Seattle, WA. “We included information about new randomized trials, systematic reviews, and some observational studies.

“We have brought this up to the current standard of guideline development, which is to make them more comprehensive, more transparent, and more in-line with the recommendations from the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) for developing trustworthy guidelines. We also included a patient representative on the panel.”

The guideline includes three new action statements:

  • A renewed emphasis on primary prevention among patients at risk for the condition, including commentary for patients to take greater care in cleaning ears. It is recommended they avoid the use of cotton-tipped applicators, bobby pins, and sharp objects because of the potential for harm.
  • A recommendation against ear candling now has its own statement to emphasize the message. Previously, the recommendation was part of another statement.
  • It is recommended that patients who do not have a good response to initial treatment be referred for advanced therapy and that the impaction be managed until it is resolved.

Recommendations for the diagnosis and management of cerumen impaction in the guideline have no significant changes, Dr. Schwartz said. The primary management strategies are to use irrigation, drops, or manual removal of cerumen with instrumentation.

“There is a new algorithm for walking clinicians through the management of these patients, starting with presenting with cerumen or with symptoms related to cerumen,” he said. “It walks through how you would manage the patient, with references to the different guideline statements to make it more user-friendly, including pictures and illustrations.”

One area of emphasis is for young children or cognitively impaired adults who cannot communicate their symptoms. The guideline recommends more aggressive management for removal of cerumen because these patients may not be able to complain about impaction, Dr. Schwartz said.

Even though the guideline does not break new ground scientifically, it was important to update it to deal with such a common condition.

“The point is that we, as the specialists in this area, want to take ownership of this,” Dr. Schwartz said. “The guideline is much more for primary care clinicians who are typically the first line of treatment for these patients.

“We are the stewards of this knowledge and the ultimate endpoint for care when patients have more complicated issues related to cerumen impaction. That is why the Academy has taken ownership of this and feels it is important to have a guideline about it.”

The other panelists at the session will be Anthony E. Magit, MD, clinical professor of otolaryngology at the University of California, San Diego, School of Medicine, and Richard M. Rosenfeld, MD, MPH, professor, chairman, and otolaryngology program director, SUNY Downstate Medical Center.

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