5
5A. Recommended
interventions
Clinicians should treat, or refer to a clinician
who can treat, the patient with cerumen
impaction with an appropriate intervention,
which may include one or more of the
following : cerumenolytic agents, irrigation, or
manual removal requiring instrumentation.
R-B
5B. Contraindicated
intervention (ear
candling/coning )
Clinicians should recommend against ear
candling/coning for treating or preventing
cerumen impaction.
R-C
(against)
6. Cerumenolytic agents Clinicians may use cerumenolytic agents
(including water or saline solution) in the
management of cerumen impaction.
O-C
7. Irrigation Clinicians may use irrigation in the
management of cerumen impaction.
O-B
8. Manual removal Clinicians may use manual removal requiring
instrumentation in the management of
cerumen impaction.
O-C
9. Outcomes assessment Clinicians should assess patients at the
conclusion of in-office treatment of cerumen
impaction and document the resolution of
impaction. If the impaction is not resolved,
the clinician should use additional treatment.
If full or partial symptoms persist despite
resolution of impaction, the clinician should
evaluate the patient for alternative diagnoses.
R-C
10. Referral and
coordination of care
Clinicians should refer patients with persistent
cerumen impaction aer unsuccessful
management by the initial clinician to a
clinician with specialized equipment and
training for cleaning and evaluating the ear
canal and tympanic membrane.
R-C
11. Secondary prevention Clinicians may educate/counsel patients
with cerumen impaction/excessive cerumen
regarding control measures.
O-C
Table 1. Summary of Guideline Key Action Statements (KAS)
(cont'd)
Statement Action Strength
