![]() ![]() perforation or infection), I talk about the value of self-irrigation of the external ear canals with water and to refrain from using cotton buds. Providing there are no contraindications (eg. For all patients presenting with wax related problems, I take the time to talk about aural hygiene. The literature is not clear as to whether using cerumenolytic drops are beneficial to water alone (2,3). I also began to understand the misperception that water is not good to get in the ears (it is only contraindicated in a small population of people for specific reasons). The more I regularly spoke with patients about this basic subject, I more I realized that many patients did not appreciate the improper use of cotton buds. I, not infrequently, saw patients in the office with a piece of cotton bud broken off in the ear, and occasionally a perforation that resulted from cotton bud trauma. I also took for granted that patients knew that cotton buds are not for use in the external canals – a major factor contributing to wax impactions as well as potentially having more serious morbidity. The more time I spent on explaining to patients how to care for their ears and related wax build-up, the less wax problems I encountered in the office. Wax build-up is a bothersome problem for patients and this is, for the large part, preventable. Counseling patients on preventative measures for wax build-up was something I did not routinely do in the past, spending more time on the management of the problem. In the case of Family Physicians, syringing is often utilized, which is time-consuming and cumbersome, and sometimes without the desired response. This has been an evolution in my practice for over a decade or more, where previously curetting and vacuuming was a regular occurrence in my clinical office. I previously spent more time cleaning wax in the office, but less so as time went by. For patients this can sometimes result in sensation of blocked ears, pain and even hearing loss. ![]() If not managed well, this can result in persistent wax build-up (or impaction) for patients and added time to a busy physician’s office – sometimes without effective resolution in the short term. According to McCarter et al cerumen impaction is present in approximately 10 percent of children, 5 percent of normal healthy adults and up to 57 percent of older patients in nursing homes (1). Michael Clifford Fabian, FRCPC FRCSC FACS ( biography and disclosures)Ĭerumen build-up is a common problem for patients and doctors alike. ![]()
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