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Colorado Springs

Audiology, Inc.

 

 

Phone  719.520.1155

LOCATION  & DIRECTIONS

 

 

Dr. Gene McHugh

Licensed Audiologist

In Colorado

OFFICE HOURS

Mountain Time USA

Mon-Thurs

9:00AM-5:00PM

Closed Fridays

 

 © Copyright 2017

 

 

 

 

EAR CLEANINGS AND CERUMEN MANAGEMENT
 

What is earwax and why is it a problem?  It is normal for the skin in the ear canal to replenish and thereby clean itself by moving toward the outer opening of the ear canal. It mixes with cerumen glands in the outer one-third, breaks up and normally falls out. The mixture is called cerumen or earwax.  A little earwax is fine and actually has helpful medicinal qualities as it traps sand or dust particles before they reach the ear drum.  It also protects the outer part of the ear canal because it repels water.  However, when cerumen abnormally accummulates rather than falling out, it can potentially interfere with sound reaching the eardrum.

      Cerumen problems affect between 2%-6% of the general population in the United States.  As the older cerumen reaches the opening of the ear, it usually dries out and falls away.  It is estimated 150,000 a week have their ears cleaned because of wax blockage. 

     Most audiologists have not been trained to use a binocular microscope (otomicroscopy)and therefore use either a hand-held otoscope or video-otoscope.  They may attempt to remove cerumen in this manner but this limits their ability to remove cerumen as safely and comfortably when compared to using an otomicroscope. 

 

 
 

  

Training to remove cerumen.  Audiologists may clean ears, but training is important.  I was trained by two ear, nose & throat physicians (otolarygologists) on the correct procedures to extract cerumen along with long-term management.  Both preferred the microscope to examine ears.  Therefore in our clinic, ear canals are likewise examined using a microscope.  This is referred as oto-microscopy  ("oto" meaning "ear").  
Manual removal.  If the cerumen can be removed using a curette or otoloop, this is the safest method and usually only mildly uncomfortable to the patient.   The otoloop shown to the left has a small angled loop.  The ear canal is much less sensitive along the top, compared to the bottom.  Therefore, the otoloop is positioned along the superior part of the canal, and the earwax gently rolled out.    Sometimes, it is possible to use alligator forceps to "grab" the cerumen and extract it.
Lavage and suction.  Only when necessary, we lavage the canal with tap water warmed to body temperature.  If the water is more than 3 degrees higher or lower than body temperature, the ear's organ for balance may be over-stimulated resulting in vertigo (albeit very slight).
While most cases are relatively easy to complete - if the cerumen impaction is beyond my comfort range  it may be necessary to refer the patient to a medical ear specialist.

Cost:  $25.00 per ear ($50.00 for both).  We do not file insurance but you may use our super bill and submit it to your insurance carrier. It is important to note that cerumen removal is not usually covered by insurance.

References of articles and tutorials by Dr. McHugh:
  1. McHugh, E. & Traynor, R. Video Otomicroscopy, A New Vision in Cerumen Management, Hearing Review (May, 2009).   

  2. McHugh, E.  Upgrading cerumen management services to otomicroscopy or video otomicroscopy  Audiology Online, (2008)   

Examples of manual removal using currettes and lavage (water).   In our office, the patient is able to watch the process.  While it would seems this is unnecessary or difficult for the patient, the fact is that is helpful to both patient and clinician.  Rarely do patients prefer not to look at the procedure.    

 

 

Manual removal of cerumen

 

 

Lavage with water going into basin

 

 

Tympanometry to verify normal eardrum mobility - only possible when earwax has been successfully excavated

 

 

Clinician and assistant completing lavage on the right ear

 

 

 

 

Tympanometry to verify successful removal of earwax and normal eardrum functional.  This patient noticed immediate iimprovement in hearing following the procedure.  He has been coming to me for the past 10 years.