6
Treatment
Figure 4. Management Algorithm
Primary complaint by
patient of cerumen
Explain
proper ear
hygiene
Otoscopy
shows
accumulation of
cerumen?
NO
Hearing aid user
END
KAS1
YES
Is cerumen
associated with
symptoms?
*
KAS2A
Cerumen seen
on routine office
examination
NO
KAS2A
YES
Diagnose impacted
cerumen
KAS2B
KAS3C
See full text
for specific
considerations
Treat with
cerumenolytic
agents, irrigation,
or manual removal
Retreat and
consider dlternate
diagnoses
KAS9
Post-
treatment
otoscopy shows
resolution?
KAS9
Document
resolution
Education on
control measures
Successful
resolution?
Refer to specialist for
further treatment
KAS10 KAS11
END END
YES
NO
YES
NO
NO
NO
NO
NO
YES
KAS5A
YES
Does clinician
consider the
amount of cerumen
significant?
Does
patient have
any modifying
factors?
**
Patient
has limited
expressive
language
***
YES
Cerumen
prevents needed
assessment of the
ear?