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Q J Med 2004; 97: 477-488
QJM vol. 97 no. 8 © Association of Physicians 2004; all rights reserved.

Review

Impacted cerumen: composition, production, epidemiology and management

J.F. Guest1, M.J. Greener1, A.C. Robinson2 and A.F. Smith3

From 1CATALYST Health Economics Consultants, Northwood, Middlesex, 2Department of Otolaryngology, West Middlesex University Hospital, Isleworth, Middlesex, and 3Alcon Laboratories Ltd, Hemel Hempstead, and Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK

In the UK, some 2.3 million people suffer cerumen (‘ear wax’) problems serious enough to warrant management, with approximately 4 million ears syringed annually. Impacted cerumen is a major cause of primary care consultation, and a common comorbidity in ENT patients, the elderly, infirm and people with mental retardation. Despite this, the physiology, clinical significance and management implications of excessive and impacted cerumen remain poorly characterized. There are no well-designed, large, placebo-controlled, double-blind studies comparing treatments, and accordingly, the evidence surrounding the management of impacted cerumen is inconsistent, allowing few conclusions. The causes and management of impacted cerumen require further investigation. Physicians are supposed to follow the edicts and principles of evidence-based medicine and clinical governance. Currently, in patients with impacted cerumen, the lack of evidence makes this impossible.

Address correspondence to Dr J.F. Guest, CATALYST Health Economics Consultants, 34b High Street, Northwood, Middlesex HA6 1BN. e-mail: julian.guest{at}catalyst-health.co.uk


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