ABSTRACT
The removal of cerumen requires gentleness and patience and always should be performed with good illumination. The simplest method that suits the situation should be used. Firm plugs of wax can be removed best en masse by gently teasing them out with fine forceps. The forceps or any other instrument should come in contact with the wax only and not with the skin of the canal, which ~s thin and tender. Soft wax can be wiped out with a curette or a very thin, cotton-tipped probe. Using cotton swabs to remove wax from a narrow canal only pushes it in further and impacts it. Sometimes, it may be necessary to irrigate wax from an ear canal, but this should be avoided if the canal already is inflamed. Irrigation should not be performed in the presence of a known perforation of the eardrum, because this may cause a dry ear to flare up and result in otitis media. When irrigation is performed, the water used should be at body temperature to avoid stimulating the labyrinth and producing vertigo. The stream of water is most effective when it is directed forcefully toward one edge of the wax so that the water can get behind the plug and force it out. The ear canal should be dried carefully at the end of the procedure.
