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Table 1. Summary of Guideline Key Action Statements (KAS)
Statement Action Strength
1. Primary prevention Clinicians should explain proper ear hygiene
to prevent cerumen impaction when patients
have an accumulation of cerumen.
R-C
2A. Diagnosis of cerumen
impaction
Clinicians should diagnose cerumen
impaction when an accumulation of cerumen
as seen on otoscopy 1) is associated with
symptoms, or 2) prevents needed assessment
of the ear, or 3) both.
R-B
2B. Modifying factors Clinicians should assess the patient with
cerumen impaction by history and/
or physical examination for factors that
modify management such as one or more
of the following : anticoagulant therapy[D]
immunocompromised state[D], diabetes
mellitus[C], prior radiation therapy to
the head and neck[C], ear canal stenosis,
exostoses, non-intact tympanic membrane[D].
R-C/D
3A. Need for intervention if
impacted
Clinicians should treat, or refer to another
clinician who can treat, cerumen impaction
when identified.
S-B
3B. Non-intervention if
asymptomatic
Clinicians should not routinely treat cerumen
in patients who are asymptomatic and whose
ears can be adequately examined.
R-C
3C. Need for intervention in
special populations
Clinicians should identify patients with
obstructing cerumen in the ear canal who
may not be able to express symptoms (young
children and cognitively impaired children
and adults) and promptly evaluate the need
for intervention.
R-C
4. Intervention in hearing
aid users
Clinicians should perform otoscopy to detect
the presence of cerumen in patients with
hearing aids during a health care encounter.
R-C
Key Points
