Manual removal of cerumen (ear wax) may be contraindicated if certain conditions are present. However, it can often be used when other methods of cerumen removal are contraindicated.
Patient selection: cerumen impaction
Contraindications to manual cerumen removal:
(1) immunosuppression (HIV, transplant, other)
(2) diabetes
(3) chronic anticoagulation (at least while anticoagulated)
(4) anatomical anomalies that make instrument use difficult
(5) malignant otitis externa
Diabetes and some cases of immunosuppression can be manually disimpacted, but caution must be taken to avoid trauma to the external auditory canal.
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