Cerumen Management Workshop



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Cerumen Management Workshop

Rita R. Chaiken, Au.D.


I. Overview of the Workshop

Why should audiologists perform cerumen management?

II. Case History for Cerumen Management


  1. Ear Pathology Hx


  1. General Health Hx


  1. Medications

Herbal supplements and OTC interactions:
http://faculty.ksu.edu.sa/hisham/Documents/Pharmacy_Docs/herbal_drug_interactions.pdf
www.inetce.com/articles/pdf/221-999-05-056-H01.pdf
For drug-drug interactions go to: www.drugs.com/drug_interactions.php

  1. Otoscopic Examination

III. Anatomy and Physiology of the External Ear.




figure#2ear canal anatomy copy



  1. External Ear Canal Structure:



  1. Anteroinferior wall - approximately 6 mm longer than posterosuperior wall




  1. Anterior and superior walls - less sensitive than the posterior and inferior walls




  1. Isthmus




  1. Fissures of Santorini




  1. Cranial Nerve Innervation

Arnold’s Reflex





  1. Blood Supply

IV. Conditions of the Outer Ear


rcsullivan.com Video Otoscopy in Audiology Practice

V. Cerumen Production





  1. Types of Glands

Ceruminous

wax glands Sebaceous


  1. Cerumen Migration



  1. Causes of cerumen build-up



  1. Problems caused by cerumen impaction



  1. Effects and causes of cerumen insufficiency



  1. Incidence of cerumen impaction



  1. Cerumen color variance

VI. Otoscopy/Lighting




A .Types of otoscopes


B. Video otoscopes




  1. Oto-microscopes (see additional instruction handout)



  1. Binocular loupes (see additional instruction handout)


  1. Head lamps/ magnified binocular head lamps

VII. Furniture requirements




  1. Professional seating



  1. Patient Seating



  1. Housing of instruments and equipment

VIII. Methods of Cerumen Management
Softening agents

Debrox toolkit: 866.646.7787






  1. Instrumentation


figure#1 copy


    1. Curettes


    1. Loops



    1. Spoons




    1. Hooks




    1. Earlights




    1. Lighted Curettes




    1. Video otoscope attachments




    1. Forceps



figure#2 copy


  1. Suction



    1. Contraindications




    1. Equipment




    1. Suction tubes

1190420 11904351190405


    1. Protocol


  1. Irrigation




    1. Contraindications




    1. Equipment




    1. Protocol


instruments1

IX. Post Cerumen Management Problems

X. Counseling Patients

XI. Scope of Practice

XII. Liability
XIII. Charges/Claims


  1. Medicare

69210
92700


Voluntary ABN
GY/GX modifiers
G0268



  1. Other Insurances

XIV. Infection Control




  1. Cleaning



  1. Disinfecting



  1. Sterilizing

Autoclave


Gluteraldehyde

Hydrogen peroxide


Instructions for Setting Loupes/Microscopes

Seiler/Jedmed Set intraocular distance: loosen screws under eye piece

Sport Loupe: Focus on object 10” away and turn knob moving eye pieces

laterally until one image viewed

Press blue switch on black power supply to turn unit on

Change distance to the object (closer or farther away) as

needed for clarity

Turn light off when not using.

Heine/Jedmed Set optics assembly as close to the eyes as possible

Loupe: Center the light beam to the visual field

Set intraocular distance: loosen screws under eye piece

Focus on object 10” away and move eye pieces laterally

until one image viewed

Change distance to the object (closer or farther away) as

needed for clarity

Turn LED lamp on with switch

Turn light off when not using

Prescotts

Otomicroscope: Sit at eye/ear level

Turn light on and adjust brightness

Center the light beam to the visual field

Look thru binocular lens and focus at .6

Set pupillary distance (binocular lens) – see one ear in

both eyes

Use fine focus to control depth perception field of vision

Change distance to the object (closer or farther away) as

needed for clarity


Audiological Consent Form

(This is a sample form which may not suffice in your jurisdiction)


Patients Name:


I have been given information about my condition and consent is here by voluntarily given for:

  • Lyric Instrument Extended Wear Fitting and Sizing

  • Cerumen (Earwax) Removal

The procedure, alternatives, potential gains and risks have been explained to my satisfaction.

  • Lyric extended wear fitting and sizing risks are rare and include: abrasion, discomfort, soreness, bleeding, infection and pain.

  • Cerumen removal risks are rare and may include: abrasion, discomfort, soreness, bleeding, infection and pain.

Patients Signature Date


Witness Signature Date

Cerumen Management Course Glossary of Terms
Actinic Lesion- precancerous lesion
Acute Otitis Externa (Bacterial) - inflammation of the skin and sub epithelial tissue
Acute Otitis Externa (Localized) - abscess of the hair follicle that occurs from obstruction of the apo-pilosebaceous unit.
Basal Cell Carcinoma- uncommon in the EAC
Cerumenoma- benign growth of the apocrine and sebaceous glands within the cartilaginous canal
Cholesteatoma of the EAC- accumulation of exfoliated keratin from the external canal
Exostoses- multiple boney lesions in the EAC
Hematoma- blood tumor
Keratosis Obturans- keratin debris accumulation within the external canal - may cause erosion of the bony canal
Melanoma- tumor of the melanocytes in the skin which should always be regarded as systemic illness
Osteoma- unilateral bony tumor
Otorrhea- odorous discharge from the ear
Otalgia- ear pain
Otomycosis- infection of the EAC caused by fungus and yeast
Papilloma- DNA virus usually appearing in the pinna and entrance of the EAC
Squamous Cell Carcinoma- most common malignant tumor of the EAC
Source:Canalis, Rinaldo, Lambert, Paul R, THE EAR, Lippincott, Williams & Wilkins 2000, Philadelphia, PA




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