34 78 Definition Waxlike, soft, yellowish-brown secretion found in external canal of the ear. Ear wax can be wet (honey brown to dark brown and moist) or dry (grey and flaky). Ear wax is helpful in normal amounts and serves to coat the skin of the ear canal where it acts as a temporary water repellent. Absence of ear wax may result in dry, itchy ears. Generally, wax deposit does not have to be removed unless it becomes impacted and interferes with hearing. Characteristics Clinical manifestations include partial deafness, tinnitus, dizziness, sensation of fullness or ear pain, or abnormal audiogram. Policy Evaluate employee in the occupational health unit to determine whether foreign body or im- pacted ear wax (cerumen) is in the ear canal. Objectives Clinical Assessments and Interventions Referral for Medical Action Ear Wax (Cerumen) ● History of draining ears, ear perfo- ration, or other complications from previous ear irrigation. ● Prolonged pain. Follow-up Actions ● Inform employee that wax in ears is normal and is constantly being transported from the ear canal to the ear opening where it usually dries, flakes, and falls out. ● For employee who has history of recurrent problems with ear wax, suggest 2 drops of mineral oil, baby oil, glycerin, or commercial ear wax removal drops in ears 1 day a week at bedtime to help liquefy ear wax. ● Advise employee to avoid putting any foreign objects into ear, such as toothpicks, hair pins, paper clips, and the like. ● Cotton swabs should be used with care on outer ear canal but not inserted into canal. Determine extent of problem. Remove excess wax deposits. ● Inspect external ear canal. ● Instill 5 to 10 drops of carbamide peroxide (Debrox, Murine) twice a day for 3 to 4 days after fourth day, irrigate gently with warm water. Also can instill liquid docusate sodium (stool softener) followed by irriga- tion, loosening the wax. When irrigating ear, direct stream of water to top of ear canal so stream of water flows above and behind wax, pushing it out. Irrigating straight back can impact cerumen against the tympanic membrane, causing increased discomfort. ● If hygroscopic foreign body (material that absorbs water, such as vegetable matter) is in ear, do not irrigate ear canal because this may further impact the ear. ● Re-inspect ear to see if all wax has been removed. Guideline continues on next page