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A Journal on Forensic Medicine
Minerva Medicolegale 2010 June;130(2):117-21
Impacted cerumen: medicolegal aspects
Beatrice F., Bucolo S., Massimelli M.
1 Struttura Complessa di Otorinolaringoiatria, Ospedale San Giovanni Bosco, ASL-TO2, Torino, Italia
2 Dipartimento di Anatomia, Farmacologia e Medicina Legale, Università degli Studi di Torino, Torino, Italia
Numerous primary care patients will consult their clinician for cerumen impaction, and cerumen removal is the most common ear, nose, and throat procedure performed in the hospital outpatient care setting. Cerumen impaction is more common in the elderly and in patients with cognitive impairment. Asymptomatic cerumen often does not require active management. Symptoms associated with cerumen impaction include, but are not limited to: hearing loss, tinnitus, fullness, otalgia, discharge, or cough. Recent researches suggest that cerumen supports bacterial growth, rather than being antibacterial. Cerumen impaction may impair a clinician’s ability to visualize the tympanic membrane and assess the status of the middle ear. Multiple treatment options exist for cerumen impaction, including observation; cerumenolytic agents; irrigation; or manual removal other than irrigation. A number of clinical studies assess the efficacy and safety of cerumen softeners. However, there is a need for further well designed, large, placebo-controlled, double-blind studies. The training, skill, and experience of the clinician play a significant role in the treatment option selected. In addition, patient presentation, preference, and urgency of the clinical situation influence choice of treatment. Though generally safe, treatment of cerumen impaction can result in significant complications. Several complications such as tympanic membrane perforation, ear canal laceration, infection of the ear, or hearing loss can occur. Post-treatment evaluation for complications of the removal procedure is important for patient safety and medico-legal purposes.