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Manual Cerumen Removal

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1. Earwax (Cerumen Impaction)

be treated with an appropriate intervention, including one or more of the following: cerumenolytic agents, irrigation, or manual removal requiring instrumentation. Individuals should be discouraged from using ear candling for the treatment or prevention of cerumen impaction. Individuals should be reassessed at the conclusion of in-office treatment of cerumen impaction and the resolution of impaction should be documented. If the impaction is not resolved, additional treatment should be prescribed. If full (...) Earwax (Cerumen Impaction) Cerumen Impaction -- Clinical Recommendation Welcome Search Search Specify your search AAFP.org Patient Care Clinical Practice Guideline Earwax (Cerumen Impaction) (Endorsed, August 2016) The updated guideline, Earwax (Cerumen Impaction) , was developed by the American Academy of Otolaryngology-Head and Neck Surgery and endorsed by the American Academy of Family Physicians. Key Recommendations Individuals with an accumulation of cerumen should be counseled on proper

2016 American Academy of Family Physicians

2. Manual Cerumen Removal

. liver failure) (including ) risk factors (e.g. , , ectodermal dysplasia) Prior head and neck radiation (ear canal dryness results in greater with wax removal) Anatomic abnormalities (e.g. auditory canal stenosis, s) VIII. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Manual Cerumen Removal." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database (...) Removal Aka: Manual Cerumen Removal , Ear Curette , Cerumen Removal By Instrumentation II. Indications III. Precautions Perform under direct visualization if possible Always keep distance in mind caution in groups at risk for complications External otitis ( , immunocompromised, ) IV. Preparations: Curettes Jobson-Horne loop (wire probe with "O" at end) Buck's #1 cerumen spoon Plastic loops/spoons: unlikely to damage canal V. Management: Manual Removal Technique (effective in 97% children) Steady hand

2018 FP Notebook

3. Cerumen impaction

membrane. Intervention may include manual removal, irrigation, or use of cerumenolytic agents, or a combination of these modalities. After treatment, the clinician should re-examine the patient's ear and document the resolution of the cerumen impaction, and also inspect the previously occluded tympanic membrane. Young children, older patients, cognitively impaired people, and those in nursing homes are at high risk for cerumen impactions. Hearing-aid users are also at increased risk. These groups (...) ): Earwax (Cerumen Impaction). Otolaryngol Head Neck Surg. 2017 Jan;156(1_suppl):S1-S29. http://journals.sagepub.com/doi/abs/10.1177/0194599816671491 http://www.ncbi.nlm.nih.gov/pubmed/28045591?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: Cerumen accumulation Reprinted with permission from: Hawke M. Ear disease: a clinical guide. Hamilton, London: Decker DTC; 2003 [Citation ends]. History and exam presence of risk factors visualisation of cerumen hearing loss

2018 BMJ Best Practice

4. Cerumen Impaction Full Text available with Trip Pro

include ≥1 of the following: cerumenolytic agents, irrigation, or manual removal requiring instrumentation. (8) Clinicians should recommend against ear candling for treating or preventing cerumen impaction. (9) Clinicians should assess patients at the conclusion of in-office treatment of cerumen impaction and document the resolution of impaction. If the impaction is not resolved, the clinician should use additional treatment. If full or partial symptoms persist despite resolution of impaction (...) specifically designed for ear cleaning and wax removal at home are readily available and easy to purchase at markets and pharmacies. While objects for cleaning are ubiquitous, patients should be counseled not to insert any foreign objects into the ear canal, as these objects can cause injuries or worsen cerumen impaction by pushing cerumen deeper into the canal. Susceptible patients can use some measures at home to control accumulation of cerumen. Common self-help measures include cerumenolytic drops

2017 American Academy of Otolaryngology - Head and Neck Surgery

5. Risk of Otitis Externa Following Manual Cerumen Removal. (Abstract)

Risk of Otitis Externa Following Manual Cerumen Removal. Based on an interpretation of a recent Joint Commission protocol to sterilize instruments coming into contact with mucous membranes, there has been institutional interest in sterile packaging of cerumen curettes used for manual cerumen removal. To date, there are no studies that have assessed the risk of otitis externa (OE) following cerumen removal and the utility of sterile packaging is questionable. The objective of this study (...) is to assess the incidence of OE following cerumen disimpaction prior to the implementation of sterile packaging at our institution.This was a retrospective chart review. Over a I-year period, 1457 episodes of manual cerumen removal took place in the otolaryngology clinic. Charts were assessed for signs or symptoms of OE within 2 weeks of the procedure through follow-up phone calls and clinic visits in the otolaryngology division.There were no patients who followed up with symptoms or signs suggestive

2014 Rhinology and Laryngology

6. Manual Cerumen Removal

. liver failure) (including ) risk factors (e.g. , , ectodermal dysplasia) Prior head and neck radiation (ear canal dryness results in greater with wax removal) Anatomic abnormalities (e.g. auditory canal stenosis, s) VIII. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Manual Cerumen Removal." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database (...) Removal Aka: Manual Cerumen Removal , Ear Curette , Cerumen Removal By Instrumentation II. Indications III. Precautions Perform under direct visualization if possible Always keep distance in mind caution in groups at risk for complications External otitis ( , immunocompromised, ) IV. Preparations: Curettes Jobson-Horne loop (wire probe with "O" at end) Buck's #1 cerumen spoon Plastic loops/spoons: unlikely to damage canal V. Management: Manual Removal Technique (effective in 97% children) Steady hand

2015 FP Notebook

7. Cerumen Softening Agents

Softening Agents Aka: Cerumen Softening Agents , Ceruminolytic From Related Chapters II. Contraindications s III. Indications Acute with pain or Instill softening agents in ear for 7-14 days May require manual removal of residual debris Prior to a scheduled ear exam (start 2-3 weeks before) Chronic IV. Preparations: Water-based agents Hydrogen Peroxide or Benzalkonium chloride (Zephiran) Mix 1:1 with diluted white vinegar Instill qd-bid for 4-14 days Acetic acid 2.5% (more effective in children) 10 (...) minutes before irrigation Options (Triethanolamine) 10% Hydrogen Peroxide (3%) Water Saline (as effective as other agents above) VIII. Protocol: Acute Cerumen Impaction - home program Instill several drops of any preparation listed above Repeat three times daily for 7-14 days IX. Protocol: Chronic or recurrent Cerumen Impaction Perform on scheduled basis Three drops or almond oil each ear (olive oil appears ineffective, see above) Three times daily Three weeks Three times per year After instilling

2018 FP Notebook

8. Earwax

cells on the outer layers of the skin), cerumen (a wax-like substance produced by ceruminous glands, which are modified sweat glands), sebum (from sebaceous glands), and various foreign substances (for example cosmetics and dirt) [ ; ; ; ]. Earwax has several functions. It aids removal of keratin from the ear canal (earwax naturally migrates out of the ear, aided by the movement of the jaw). It cleans, lubricates, and protects the lining of the ear canal, trapping dirt and repelling water (...) cotton buds as these push the earwax deeper into the canal. Wear a hearing aid or ear plugs as this prevents the wax being excreted. Although evidence for increased risk of cerumen impaction in people who wear hearing aids is weak. [ ; ; ; ; ; ; ] Prevalence How common is it? In the UK, it is estimated that 2.3 million people each year have problems with earwax which are sufficient to warrant intervention [ ]. Earwax removal is the most common ENT procedure performed in primary care

2016 NICE Clinical Knowledge Summaries

9. Cerumen Softening Agents

Softening Agents Aka: Cerumen Softening Agents , Ceruminolytic From Related Chapters II. Contraindications s III. Indications Acute with pain or Instill softening agents in ear for 7-14 days May require manual removal of residual debris Prior to a scheduled ear exam (start 2-3 weeks before) Chronic IV. Preparations: Water-based agents Hydrogen Peroxide or Benzalkonium chloride (Zephiran) Mix 1:1 with diluted white vinegar Instill qd-bid for 4-14 days Acetic acid 2.5% (more effective in children) 10 (...) minutes before irrigation Options (Triethanolamine) 10% Hydrogen Peroxide (3%) Water Saline (as effective as other agents above) VIII. Protocol: Acute Cerumen Impaction - home program Instill several drops of any preparation listed above Repeat three times daily for 7-14 days IX. Protocol: Chronic or recurrent Cerumen Impaction Perform on scheduled basis Three drops or almond oil each ear (olive oil appears ineffective, see above) Three times daily Three weeks Three times per year After instilling

2015 FP Notebook

10. Earwax Full Text available with Trip Pro

, if this is not sufficient, the most common method of cerumen removal is with warm water. A method is more likely to be used by and when the ear canal is partially occluded and the material is not adhering to the skin of the ear canal. , on the other hand, push most of the earwax farther into the ear canal and remove only a small portion of the top layer of wax that happens to adhere to the fibers of the swab. Softeners [ ] Main article: This process is referred to as cerumenolysis . Topical preparations for the removal (...) ) to the walls of the ear canal, and move towards the entrance of the ear canal. The cerumen in the ear canal is also carried outwards, taking with it any particulate matter that may have gathered in the canal. Jaw movement assists this process by dislodging debris attached to the walls of the ear canal, increasing the likelihood of its expulsion. Removing earwax is in the scope of practice for and (ear, nose, and throat) doctors. Lubrication [ ] The lubrication provided by cerumen prevents of the within

2012 Wikipedia

11. Hearing loss in adults: assessment and management

earwax (see recommendations 1.2.1 to 1.2.5 on removing earwax) or acute infection, they have any of: partial or complete obstruction of the external auditory canal that prevents full examination of the eardrum or taking an aural impression pain affecting either ear (including in and around the ear) that has lasted for 1 week or more and has not responded to first-line treatment a history of discharge (other than wax) from either ear that has not resolved, has not responded to prescribed treatment (...) the ear or take an impression of the ear canal. 1.2.2 Do not offer adults manual syringing to remove earwax. 1.2.3 Consider ear irrigation using an electronic irrigator, microsuction or another method of earwax removal (such as manual removal using a probe) for adults in primary or community ear care services if: the practitioner (such as a community nurse or audiologist): has training and expertise in using the method to remove earwax is aware of any contraindications to the method the correct

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

12. ASTRO Guideline on Definitive and Postoperative Radiation Therapy for Basal and Squamous Cell Cancers of the Skin

Development — Consensus is evaluated using a modified Delphi approach. Task force members confidentially indicate their level of agreement on each recommendation based on a 5-point Likert scale, from “strongly agree” to “strongly disagree”. A prespecified threshold of =75% (=90% for expert opinion recommendations) of raters that select “strongly agree” or “agree” indicates consensus is achieved. Recommendation(s) that do not meet this threshold are removed or revised. Recommendations edited in response (...) available interventions for primary cutaneous BCC. It concluded that recurrence rates were similar for excision (3.8%), Mohs surgery (3.8%), and external-beam radiation (3.5%). 19 This body of evidence underpins the guidance that definitive radiation may be considered as a curative option when surgery can compromise function or cosmesis in an anatomically sensitive area. Good functional outcomes are especially relevant for commonly sun-exposed area of the face (eg, ears, nose, lips, eyelids). Careful

2020 American Society for Radiation Oncology

13. Infection Control for Haemodialysis Units

benefits and harms is needed for the impact of screening for multiple organisms in the non-epidemic setting as these are the settings in which these guidelines would be most often applied. GUIDELINE DEVELOPMENT PROCESS The overall approach to guideline development followed by KHA-CARI follows the GRADE framework as detailed in the KHA-CARI Development Manual (www.cari.org.au). In brief, guideline development follows a five-stage process. Stage 1: Scoping and identification of subtopics Stage 2 (...) ____________________________________________________________________________________________________________ Infectious diseases in haemodialysis units November-2018 Page 6 of 63 patients. No drugs or materials from the dialysis station should be returned to the preparation area (1C). e) We recommend needles be dispensed into a sharps container. Containers should be designed to allow for non-touch technique (1D). f) We recommend that external circuits, once removed, be transported from the dialysis station in a leak-proof bag to a designated clinical waste area. If components require reprocessing or the circuit

2019 KHA-CARI Guidelines

14. Nosebleed (Epistaxis) Full Text available with Trip Pro

University of Virginia School of Medicine, Charlottesville, Virginia, USA by this author for this author , , MD, MPH 4 Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA by this author for this author , , MD, MPH, MBA 5 SUNY Downstate Medical Center, Brooklyn, New York, USA by this author for this author , , MD 6 Ear Nose Throat of Georgia, Atlanta, Georgia, USA by this author for this author , 7 Consumers United for Evidence-Based Healthcare, Baltimore, Maryland, USA by this author (...) Pomona Pediatrics, Boston Children’s Health Physicians, Pomona, New York, USA by this author for this author , , MD 14 Massachusetts Eye and Ear, Boston, Massachusetts, USA by this author for this author , , MSN, APRN 15 Emory University Hospital Midtown, Atlanta, Georgia, USA by this author for this author , , MD, MPH 16 Georgetown University, Washington, DC, USA by this author for this author , , MD 17 Nationwide Children’s Hospital/The Ohio State University, Columbus, Ohio, USA by this author

2020 American Academy of Otolaryngology - Head and Neck Surgery

15. Sudden Hearing Loss Full Text available with Trip Pro

in one or both ears. The hearing loss in SHL may be a conductive hearing loss (CHL), sensorineural hearing loss (SNHL), or mixed hearing loss, defined as both CHL and SNHL occurring in the same ear. CHL and the conductive component of mixed hearing loss may be due to an abnormality in the ear canal, tympanic membrane (“ear drum”), or middle ear. Physical examination will help determine if there is obstructing cerumen or a foreign body in the ear canal, if there is a perforation of the tympanic (...) : None Supporting Text The purpose of this statement is to emphasize that the differentiation of CHL from SNHL is essential for defining potential treatments and prognosis. These 2 common causes of hearing loss can be diagnosed by a combination of history, physical examination including tuning fork tests, and audiometry. CHL and SNHL have markedly different management strategies, and there is good evidence that CHL, such as that from cerumen impaction or middle ear effusion, can be treated

2019 American Academy of Otolaryngology - Head and Neck Surgery

16. Guidelines of care for the management of cutaneous squamous cell carcinoma Full Text available with Trip Pro

cancer (keratinocyte carcinomas) in the U.S. population, 2012. JAMA Dermatol . 2015 ; 151 : 1081–1086 | | | a thorough understanding of the management of cSCC and the evidence on which recommendations are based is critically important for optimal patient care. Grading and staging A universally accepted staging system for risk stratification of cSCC is not yet available. Until 2010, cSCC was grouped in the American Joint Committee on Cancer (AJCC) staging manual with a multitude of other cutaneous (...) malignancies. x 17 Greene, F.L. American Joint Committee on Cancer, American Cancer Society. AJCC Cancer Staging Manual. 6th ed. Springer , New York ; 2002 | In the seventh edition of the staging manual, which was published in 2010, cSCC was specifically addressed in the chapter “Cutaneous Squamous Cell Carcinoma and Other Cutaneous Carcinomas.” x 18 Edge, S.B. American Joint Committee on Cancer, American Cancer Society. AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual. 7th ed. Springer

2018 American Academy of Dermatology

18. Evaluation and Treatment of Hirsutism in Premenopausal Women Full Text available with Trip Pro

suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth ( i.e. , in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder (...) and the response of the hair follicle to the local androgen milieu. Thus, there are two main approaches to the management of hirsutism that may be used either individually or in combination: (1) pharmacologic therapies that target androgen production and action, and (2) direct hair removal methods (electrolysis and photoepilation). Most women also use cosmetic measures (shaving, plucking, waxing) before their first medical consultation and continue to use them during pharmacotherapy. We suggest pharmacotherapy

2018 The Endocrine Society

19. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology Full Text available with Trip Pro

device, RT, 2 h Suspected agent of bioterrorism Refer to CDC website for specimen collection and shipping: Serology 5 mL serum Clot tube, RT, 2 h Antigen test As described in the laboratory specimen collection manual Closed container, RT, 2 h NAAT 5 mL plasma EDTA tube, RT, 2 h Other specimen, ie, viral transport medium Closed container, RT, 2 h Specimen Type Specimen Required Collection Device, Temperature, and Ideal Transport Time Aerobic bacterial culture Tissue, fluid, aspirate, biopsy, etc (...) transport device, RT, 2 h Virus culture Tissue, fluid, aspirate, biopsy, etc Viral transport media, on ice, immediately Swab; flocked swabs are recommended Virus swab transport device, RT, 2 h Suspected agent of bioterrorism Refer to CDC website for specimen collection and shipping: Serology 5 mL serum Clot tube, RT, 2 h Antigen test As described in the laboratory specimen collection manual Closed container, RT, 2 h NAAT 5 mL plasma EDTA tube, RT, 2 h Other specimen, ie, viral transport medium Closed

2018 Infectious Diseases Society of America

20. Acoustic CR Neuromodulation for adults with chronic subjective tonal tinnitus

may be appropriate (Hobson et al. 2013). A Good Practice Guide for the provision of tinnitus services, published by the Department of Health in 2009, recommends that patients should be referred to an audiology service in cases too severe to be managed with advice and information and those not caused by ear wax or infection (Department of Health 2009). The guide states that audiology services should offer tinnitus management through a variety of measures, including information and education (...) acoustic stimulation. In most cases tinnitus is subjective, meaning that only the person can hear the sound. In rare cases people experience objective tinnitus, which can be heard during a clinical examination and arises from sounds inside the ear such as muscle spasms or altered blood flow. Tinnitus is more common in people aged over 65, but it can affect people of all ages. Although it is more common in people with hearing loss or other ear problems, one third of people with tinnitus have

2014 National Institute for Health and Clinical Excellence - Advice

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