目的:本指南提供了处理耳垢嵌塞的循证建议,定义为引起症状的耳垢积聚,阻止对耳朵的评估,或者两者兼而有之。我们认识到,“嵌塞”一词表明耳道完全被耳垢阻塞,并且我们对耳垢嵌塞的定义不需要完全阻塞。然而,耳垢嵌塞是优选的术语,因为其在临床实践中和在已发表的文献中被一致地用于描述阻止对耳朵的评估的有症状的耳垢或耳垢。本指南适用于所有可能诊断和治疗耳垢嵌塞患者的临床医生。
目的:本指南的主要目的是提高耳垢嵌塞的诊断准确性,促进对耳垢嵌塞患者的适当干预,强调对特殊人群进行评估和干预的必要性,通过结果评估促进适当的治疗选择,并加强预防耳垢嵌塞的咨询和教育。在制定本指南时,美国耳鼻咽喉头颈外科基金会选择了一个代表听力学领域的小组。家庭医学,老年病学,内科,护理,耳鼻咽喉头颈外科,和儿科。
结果:专家组强烈建议:1)临床医生应治疗引起患者表现出的症状的耳垢嵌塞,或在必要时阻止临床检查。该小组建议:1)临床医生应在耳垢积聚与症状相关时诊断耳垢嵌塞,或阻止对耳朵(外耳道或鼓膜)的必要评估,或两者兼有;2)临床医生应通过病史和/或体格检查来评估患有耳垢的患者,以了解改变管理的因素,例如以下一种或多种:不完整的鼓膜,耳道狭窄,外生骨,糖尿病,免疫受损状态,或抗凝治疗;3)临床医生应在医疗保健期间检查助听器患者是否存在耳垢嵌塞(检查频率超过每三个月,然而,没有被认为是必要的);4)临床医生应通过适当的干预措施治疗患有耳垢嵌塞的患者,其中可能包括以下一种或多种:灌溉,或除冲洗外的人工清除;5)临床医生应在门诊治疗结束时对患者进行评估,并记录嵌塞的解决情况。如果影响没有解决,临床医生应开出额外的治疗方案.如果尽管嵌塞消退,但全部或部分症状仍然存在,应考虑替代诊断。该小组提供了一种选择,即1)临床医生可以观察无症状的未受累耳垢患者,并且在需要评估时不会阻止临床医生对患者进行充分评估;2)临床医生可以区分并迅速评估可能无法表现出症状但出现耳垢阻塞耳道的患者的干预需求;3)临床医生可以用宫颈松解剂治疗患者。灌溉,或除灌溉外的手动移除;4)临床医生可以就控制措施对有耳垢嵌塞/过度耳垢的患者进行教育/咨询。
结论:本临床实践指南不旨在作为处理耳垢嵌塞的唯一指导来源。相反,它旨在通过提供基于证据的决策策略框架来帮助临床医生.它不打算取代临床判断或建立一个方案为所有个人有这种情况下,并且可能无法提供诊断和管理此问题的唯一适当方法。
OBJECTIVE: This
guideline provides evidence-based recommendations on managing cerumen impaction, defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. We recognize that the term \"impaction\" suggests that the ear canal is completely obstructed with cerumen and that our definition of cerumen impaction does not require a complete obstruction. However, cerumen impaction is the preferred term since it is consistently used in clinical practice and in the published literature to describe symptomatic cerumen or cerumen that prevents assessment of the ear. This
guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction.
OBJECTIVE: The primary purpose of this
guideline is to improve diagnostic accuracy for cerumen impaction, promote appropriate intervention in patients with cerumen impaction, highlight the need for evaluation and intervention in special populations, promote appropriate therapeutic options with outcomes assessment, and improve counseling and education for prevention of cerumen impaction. In creating this
guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of audiology, family medicine, geriatrics, internal medicine, nursing, otolaryngology-head and neck surgery, and pediatrics.
RESULTS: The panel made a strong recommendation that 1) clinicians should treat cerumen impaction that causes symptoms expressed by the patient or prevents clinical examination when warranted. The panel made recommendations that 1) clinicians should diagnose cerumen impaction when an accumulation of cerumen is associated with symptoms, or prevents needed assessment of the ear (the external auditory canal or tympanic membrane), or both; 2) clinicians should assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as one or more of the following: nonintact tympanic membrane, ear canal stenosis, exostoses, diabetes mellitus, immunocompromised state, or anticoagulant therapy; 3) the clinician should examine patients with hearing aids for the presence of cerumen impaction during a healthcare encounter (examination more frequently than every three months, however, is not deemed necessary); 4) clinicians should treat the patient with cerumen impaction with an appropriate intervention, which may include one or more of the following: cerumenolytic agents, irrigation, or manual removal other than irrigation; and 5) 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 prescribe additional treatment. If full or partial symptoms persist despite resolution of impaction, alternative diagnoses should be considered. The panel offered as an option that 1) clinicians may observe patients with nonimpacted cerumen that is asymptomatic and does not prevent the clinician from adequately assessing the patient when an evaluation is needed; 2) clinicians may distinguish and promptly evaluate the need for intervention in the patient who may not be able to express symptoms but presents with cerumen obstructing the ear canal; 3) the clinician may treat the patient with cerumen impaction with cerumenolytic agents, irrigation, or manual removal other than irrigation; and 4) clinicians may educate/counsel patients with cerumen impaction/excessive cerumen regarding control measures.
CONCLUSIONS: This clinical practice
guideline is not intended as a sole source of guidance in managing cerumen impaction. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.