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Survey of Audiologists and Cerumen Management

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Survey of Audiologists and Cerumen Management

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Abstract

Purpose: Cerumen management (CM) is within the scope of practice of audiology, and the Doctor of Audiology (AuD) is now the entry-level degree for persons practicing the profession. However, little recent information is available about whether and how CM is presently being taught in AuD programs or even if and how audiologists are currently practicing CM. This study surveyed audiologists about their training for, experience with, opinions about, and practices involving CM. Method: A questionnaire was designed for this study and was e-mailed with a link to Survey monkey.com in April and May 2011 to 1,575 audiologists with AuD degrees, randomly sampled from the American Academy of Audiology’s membership directory. Results: The return rate was 29% (447 returned). Overall, 69% of these audiologists performed CM compared to only 29% reported in earlier studies.More audiologists in private practice (87%) performed CM than those in medical settings (65%). Almost half (48%) of the audiologists who had completed residential AuD programs believed that their training programs inadequately prepared them to perform CM. Conclusion: More audiologists are performing CM than in the past. The respondents reported that they were inadequately trained in CM and believed that educational programs need to improve their coverage of CM.

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... ENTs themselves have also been reported to have problems with Ce removal [25]. This finding suggests that the risk for an incorrect diagnosis of AOM is high and that educational programs to reinforce the importance of Ce and to improve the techniques for removal should be implemented and rigorously evaluated. ...
Objectives: Under physiological conditions, cerumen (Ce) is regularly extruded from the ear canal by a self-cleaning mechanism. Failure of this mechanism leads to excessive accumulation or impaction of Ce. Limited data are available concerning the prevalence of cerumen in healthy and sick infants and children. We assessed the prevalence of Ce in a large population of infants and children and compared the Ce removal attitudes of paediatricians (PEDs) and otorhinolaryngologists (ENTs). Methods: Children seen in November 2014 for acute respiratory infections, including suspected acute otitis media, or well-being visits, were enrolled. The following data were recorded: presence, laterality, and amount of Ce; presenting complaints and final diagnosis; attempt to remove Ce during the visit; and type of physician. Results: Among 819 children aged 1 month to 12 years, Ce was present in 594 (72.5%), of whom 478 (80.5%) had bilateral Ce, and 261 (43.9%) had Ce in a relevant amount (cerumen obstructing at least 50% of the ear canal). Presence of Ce was more common in younger and in African or Asian children. PEDs were less likely to remove cerumen than ENTs (28.8% vs 91.0%, p < 0.001) irrespective of age, gender, race and reason for visit. Ce was removed by PEDs in less than one-third of sick children with a final diagnosis of acute otitis media (AOM) (31.6%) compared with almost all the children by ENTs (95.6%, p < 0.001). Conclusion: Ce is highly prevalent in healthy and sick children but is quite neglected by PEDs. Educational programs to reinforce the importance of Ce removal and to improve the techniques for removal in case of suspected AOM should be implemented and rigorously evaluated in order to avoid incorrect diagnosis and erroneous treatments.
... As such, a broad defi nition for professionals involved in hearing health was employed for the purpose of this study. The perspective of hearing health professionals has been of interest in former scientifi c studies such as M é ni è re ' s disease management, audiological rehabilitation activities, and cerumen management (Johnson et al, 2013;Smith et al, 2005;White et al, 1996). However, to our knowledge, no former study within the audiological fi eld targeted the perspective of hearing health professionals in relation to functioning of patient groups they might work with. ...
Article
Objective: To identify relevant aspects of functioning, disability, and contextual factors for adults with hearing loss (HL) from hearing health professional perspective summarized using the ICF classification as reference tool. Design: Internet-based cross-sectional survey using open-ended questions. Responses were analysed using a simplified content analysis approach to link concept to ICF categories according to linking rules. Study sample: Hearing health professionals (experts) recruited through e-mail distribution lists of professional organizations and personal networks of ICF core set for hearing loss steering committee members. Stratified sampling according to profession and world region enhanced the international and professional representation. Results: Sixty-three experts constituted the stratified sample used in the analysis. A total of 1726 meaningful concepts were identified in this study, resulting in 209 distinctive ICF categories, with 106 mentioned by 5% or more of respondents. Most categories in the activities & participation component related to communication, while the most frequent environmental factors related to the physical environment such as hearing aids or noise. Mental functions, such as confidence or emotional functions were also frequently highlighted. Conclusions: More than half (53.3%) of the entire ICF classification categories were included in the expert survey results. This emphasizes the importance of a multidimensional tool, such as the ICF, for assessing persons with hearing loss.
... The patients that most frequently require removal are in the geriatric population and the mentally disabled 1 . While removal of cerumen under the microscope is safe there are significant risks to other methods performed in the primary care clinic as well as at home 2,3 . Commonly cerumen is removed in primary care clinics via an irrigation method that has been estimated to have a 1:1000 risk of a complication including tympanic membrane perforation, ear canal laceration, and otitis externa. ...
Article
The WaxVac ear cleaning device may be a useful adjunct for patients requiring aural toilet. Cerumen removal and routine aural toilet is a common complaint that presents to the otolaryngology clinic. We tested this device to make an appropriate recommendation to our patients. We conducted in vitro testing of the WaxVac device on an artificial ear canal model and cadaveric temporal bones testing the strength of the suction, noise created by the device, and the ability of the device to remove foreign bodies from the external auditory canal. These foreign bodies included a PE tube, baby powder, a q-tip head, saline, and artificial cerumen. The WaxVac created very little suction as compared with Frazier tip suctions used in clinic. The device produced very little noise in the canal, which was equivalent to a #3 Frazier tip suction. The WaxVac was unable to remove q-tip heads or artificial cerumen from the ear canal model or the cadaveric temporal bones. Very little of the saline could be removed by the WaxVac, and only 20% to 50% of trials demonstrated removal of a PE tube. However, a large amount of the powder was able to be removed by the device. Although the concept of this device is good, the actual product does not produce adequate suction to remove cerumen or most common foreign bodies from the external auditory canal. It is unlikely to be useful for aural toilet.
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Full-text available
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Conference Paper
Background: Despite both Ireland and the United Kingdom providing free maternity care to all women, epidemiologically adverse fetal and maternal outcomes remain closely linked to social disadvantage. A European survey found 42.4% of respondents had limited functional health literacy, closely linked to economic deprivation(1). Apart from direct interpersonal consultations with a healthcare professional, traditional media and information leaflets remain the main media of communication to pregnant women. It is likely that many of these messages are not adequately communicated to those most at risk. This prospective study examined the use of digital media by pregnant women to access healthcare information for pregnancy. Objectives: The aim of this study was to assess the use of digital media in women attending for maternity care, both in general and for pregnancy-related information, and to explore the potential for expanding digital communication channels for this group of women. Methods: A standardised questionnaire was distributed to antenatal and postnatal maternity patients attending a large Dublin maternity hospital. Results: A total of 522 women responded, comprising 42% (n=218) antenatal patients and 58% (n=304) postnatal patients. There were 71% (n=372) attending public clinics and 29% (n=150) attending semi-private and private clinics, 62% (n=324) lived in Dublin and 38% were from surrounding counties (n=198), 19% (n=101) were unemployed. The majority of women surveyed (61%) were aged between 25-34 years. Most women (55%) already had at least one child. Overall 95% (n=498) used the internet to access information about pregnancy; 89% (n=90) of unemployed women used the internet to access healthcare information. Overall 76% (n=399) of women had a smartphone. Pregnancy apps for smartphones were used by 59% (n=237) of smartphone owners. Newspapers were read by only 32% (n=167) of women, while 65% (n=339) of women used the internet to access current affairs news. All women wanted some form of online/digital support during their pregnancy, including weekly text messages about pregnancy stage-specific issues (cited by 49%), a maternity smartphone app (47%) and a website for feedback regarding their care (45%). One third of women (31%) wanted a hospital Facebook page and a similar number wanted online access to their ultrasound images. Usage of digital media was similar across all age-groups with no differences between women aged less than 35 years and those aged 35 years or more. Women who already had a child were just as likely to want digital communication services for informed care of their baby as were first-time mothers. Conclusion: Digital media use in pregnant women is widespread across all socioeconomic groups, age-groups and parities. Most women use the internet to access information regarding their pregnancy. Digital communication channels are more commonly used than traditional forms of media. Health communications about pregnancy should use contemporary social media as well as the traditional media channels. References: 1) HLS-EU Consortium (2012): Comparative report on health literacy in eight EU member states. The European Health Literacy Survey HLS-EU, online publication: http://www.health-literacy.eu
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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. Purpose: 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. Disclaimer: 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.
Article
To determine the methods of removing ear wax used by local general practitioners and the incidence of associated complications. Postal survey of 312 general practitioners serving a population of about 650,000; supplementary study of ear, nose, and throat outpatients to quantify the improvement in aural acuity after wax removal. Catchment area of the Edinburgh otolaryngological unit. 289 General practitioners who responded to the survey; 21 outpatients in the ear, nose, and throat department with occlusive wax. 274 General practitioners removed wax by syringing, but only 53 (19%) always performed the procedure themselves; the remainder routinely delegated the task to practice nurses, some of whom had received no instruction. Ears were rarely examined again after the procedure. Complications had been experienced by 105 practitioners (38%) and included perforation, canal lacerations, and failure of wax removal. The removal of occlusive wax improved hearing by a mean of 5 dB over the frequencies analysed. About 44,000 ears are syringed each year in the area and complications requiring specialist referral are estimated to occur in 1/1000 ears syringed. The incidence of complications could be reduced by a greater awareness of the potential hazards, increased instruction of personnel, and more careful selection of patients.
Article
Two types of glands are found in the outer third of the human earcanal: sebaceous glands that produce sebum and modified apocrine glands that produce apocrine sweat. Together, these substances make up cerumen, which serves to clean, lubricate, and, to some extent, protect the earcanal from bacteria and fungus. Excessive/impacted cerumen can cause tinnitus, vertigo, itching, pain, external otitis, and hearing loss. Two populations are known to have a high incidence of excessive/impacted cerumen: individuals with mental retardation and the elderly. Anthropologists have used cerumen type to tract human migratory patterns and epidemiologists have related cerumen type to breast cancer.
Article
To compare general practitioner (GP) response to a telephone interview with response to a postal survey with three reminders in a randomized controlled trial. GPs were randomly assigned to either a telephone interview or a postal survey. GPs in the telephone group were mailed a letter of invitation and asked to undertake a telephone interview. GPs in the postal group were mailed a letter of invitation and questionnaire. Non-responders were sent up to three reminders, the final by registered post. Response rates were calculated for each group. 416 GPs were randomized to the telephone interview and 451 to the postal survey. Eighty-six in the telephone group and 30 in the postal were ineligible. One hundred thirty-four GPs completed the telephone interview with a response rate of 40.6% (95% confidence interval [CI]: 35.3%, 46.1%). Two hundred fifty-two GPs completed the postal survey with a response rate of 59.9% (95%CI: 55.0%, 64.6%). The difference in response was 19.3% (95%CI: 12.2%, 26.3%). These results show that postal surveys with three reminders can have superior response rates compared with a telephone interview.
Article
Cerumen is a naturally occurring, normally extruded product of the external auditory canal. It is usually asymptomatic, but when it becomes impacted it can cause complications such as hearing loss, pain, or dizziness. It also can interfere with examination of the tympanic membrane. Depending on available equipment, physician skill, and patient circumstances, treatment options for cerumen impaction include watchful waiting, manual removal, the use of ceruminolytic agents, and irrigation with or without ceruminolytic pretreatment. The overall quality of the evidence on treatment is limited. Referral to an otolaryngologist for further evaluation is indicated if treatment with a ceruminolytic agent followed by irrigation is ineffective, if manual removal is not possible, if the patient develops severe pain or has vertigo during irrigation, or if hearing loss is still present after cerumen has been removed. The use of cotton swabs and ear candles should be avoided.
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