Cerumen Impaction and Tinnitus

Clinical Presentation and Diagnosis

The American Academy of Otolaryngology-Head and Neck Surgery identifies tinnitus as a cardinal symptom of cerumen impaction, along with decreased hearing, fullness, and distortion/changes to hearing aid function, in patients with cerumen impaction 1, 2, 3
Patients with cerumen impaction may present with symptoms such as tinnitus, hearing loss, fullness, itching, otalgia, discharge, odor, and cough, as listed in the 2008 guideline 4, 5
Otoscopic examination should be performed to identify cerumen accumulation that causes symptoms or prevents complete visualization of the tympanic membrane, in patients with suspected cerumen impaction 1, 3
The presence of tinnitus should be documented as a presenting symptom in patients with cerumen impaction 6
Cerumen does not need to completely occlude the canal to cause symptoms, even partial occlusion can be problematic, in patients with cerumen impaction 3, 7

The American Academy of Otolaryngology-Head and Neck Surgery recommends treating cerumen impaction and reassessing for symptom resolution, including tinnitus, in patients with cerumen impaction 3, 6
After removing the cerumen impaction, otoscopic re-examination should be performed to confirm the cerumen has been adequately removed, and symptom reassessment should be done to determine if the tinnitus has resolved or improved, in patients with cerumen impaction 6
If tinnitus persists after confirmed removal of cerumen, alternative diagnoses such as sensorineural hearing loss, otosclerosis, cholesteatoma, otitis media, medication side effects, head and neck tumors, temporomandibular joint syndrome, or eustachian tube dysfunction should be evaluated, in patients with persistent tinnitus 6, 8

Treatment effectiveness for cerumen impaction ranges from 65% to 90% depending on the method used, with manual removal with microscopic visualization achieving approximately 90% success rates, and irrigation having lower success rates of 68% to 92%, according to the American Academy of Otolaryngology-Head and Neck Surgery 6, 8
The evidence linking cerumen impaction to symptoms, including tinnitus, is rated as Grade C with respect to signs and symptoms, though the confidence level is rated as high, by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2, 3
If initial treatment fails, combination therapy (cerumenolytic followed by irrigation or manual removal) should be used rather than simply repeating the same unsuccessful method, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 8