No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Effect of cerumen impaction on hearing and cognitive functions in Japanese older adults with cognitive impairment
Abstract
AimTo assess the effect of cerumen impaction and its removal on hearing ability and cognitive function in elderly patients with memory disorders in Japan.Methods
Pure tone audiometry (PTA) and the Mini-Mental State Examination (MMSE) were administered to participants before and after cerumen removal. Participants who had cerumen impaction in the better-hearing ear comprised the case group; the control group consisted of participants who either did not have cerumen impaction or had it in the worse hearing ear. Hearing and cognition changes were compared between the groups after cerumen removal.ResultsA total of 55 patients who completed all examinations were assigned to the case group (29 patients) or the control group (26 patients). The average hearing change was 4.6 ± 7.4 in the case group and 0.9 ± 0.9 in the control group (P = 0.029). The average change in MMSE score was 0.7 ± 2.5 in the case group and −1.0 ± 4.1 in the control group (P = 0.068). The case group showed a significant improvement in MMSE scores after age adjustment compared with the control group (P = 0.049).Conclusion
Hearing improved significantly in the case group relative to controls after cerumen removal. A significant cognitive improvement in the case group relative to controls was additionally observed after cerumen removal with age adjustment. Thus, the present results suggest routine ear canal examinations might benefit elderly individuals with memory disorders. Geriatr Gerontol Int 2014; 14 (Suppl. 2): 56–61.
... Hearing impairment might accelerate cognitive decline by compounding sensory and social isolation, increasing cognitive load, and thereby exhausting compensatory cognitive reallocation, or constitute a nonspecific marker of frailty [20]. However, the association Detection of any sound (e.g., tone) behaviourally/EP [83] Detection of short silent interval in white noise burst [76] Detection of modulation (vibrato) of intensity/pitch in carrier tone [76] Detection of right-left sound shift based on inter-aural phase/ intensity cues [76] PAC, lat HG, PT, pSTG, subcortical circuits Feature analysis Word deafness e , dystimbria f , amusia g Phoneme discrimination MBEA pitch/temporal subtests Discrimination of sound pairs/sequences differing in pitch, temporal or timbral characteristics [49,79,84] Labelling of features in a single sound (e.g., tone glide direction 'up' or 'down') [7] lat HG, pSTG/STS, aSTG, subcortical circuits Scene analysis Auditory disorientation SSI-ICM Speech-in-noise h Spatial localisation ...
... While effects on specific aspects of cognitive function are difficult to predict, correction of reversible hearing deficits has been shown to benefit global functioning in daily life [20,21,23,78,79]. Simple interventions such as earwax removal can be highly effective [79]. ...
... While effects on specific aspects of cognitive function are difficult to predict, correction of reversible hearing deficits has been shown to benefit global functioning in daily life [20,21,23,78,79]. Simple interventions such as earwax removal can be highly effective [79]. In addition, prescription of hearing aids and other assistive listening devices where appropriate, environmental modification strategies may be useful in managing altered hearing in patients with dementia. ...
Hearing deficits associated with cognitive impairment have attracted much recent interest, motivated by emerging evidence that impaired hearing is a risk factor for cognitive decline. However, dementia and hearing impairment present immense challenges in their own right, and their intersection in the auditory brain remains poorly understood and difficult to assess. Here, we outline a clinically oriented, symptom-based approach to the assessment of hearing in dementias, informed by recent progress in the clinical auditory neuroscience of these diseases. We consider the significance and interpretation of hearing loss and symptoms that point to a disorder of auditory cognition in patients with dementia. We identify key auditory characteristics of some important dementias and conclude with a bedside approach to assessing and managing auditory dysfunction in dementia.
... Hearing aids can malfunction due to cerumen impactions, causing feedback issues or clogging the ear molds, leading to a decrease in hearing (Martin, 2013;Solheim et al., 2016). Depending on the level of cerumen buildup in the EAM, hearing loss can vary from 5 to 40 decibels, which is enough to decrease cognitive function in older adults and those with developmental delays (Schwartz et al., 2017;Sugiura et al., 2014). Hearing loss in older adults may also lead to depression, loneliness, social withdrawal, or isolation if not corrected (Millward, 2017a;Mulwafu et al., 2016;Solheim et al., 2016). ...
... Providers perform cerumen removal for residents in LTCFs to relieve symptoms of cerumen impactions and improve residents' overall quality of life (Michaudet & Malaty, 2018;Mulwafu et al., 2016;Schwartz et al., 2017;Sugiura et al., 2014;Yang et al., 2016). Cerumen impaction removal is technically more diffi cult when the cerumen is hard and dry, which can be painful and less tolerable for residents (Acharya et al., 2017;Schwartz et al., 2017). ...
The current article examines the importance of educating nursing staff in a long-term care facility (LTCF) on cerumen impactions and the proper administration of cerumenolytics. An educational session on cerumen impactions and cerumenolytic administration was provided to nursing staff with pre-, post-, and follow-up tests. Findings included an increase in confidence levels of the nursing learning objectives post-education, as well as an overall improvement in knowledge retention. According to the nurses surveyed, they had never been educated on either topic. It is estimated that up to 65% of residents aged >65 years living in LTCFs are affected by cerumen impactions and the many symptoms associated with them, including hearing loss. Therefore, education on these topics for nursing staff who care for this high-risk population would be beneficial. [Journal of Gerontological Nursing, 47(4), 35-43.].
... Nonetheless, the number of adults with occluded ears who passed the 40-dB HL screen after cerumen removal was 0.4, 4.0, 6.7, and 1.8 times higher at 500, 1000, 2000, and 4000 Hz, respectively. Sugiura et al. (2014) measured pure-tone thresholds before and after cerumen removal in 29 older adults with cerumen impaction and in 26 older adults without cerumen impaction (test, retest). The mean difference in PTA4 pre-and postcerumen removal was 4.6 dB with standard deviation of 7.4 dB. ...
Purpose
U.S. national data for otoscopic examinations of 13,055 individuals aged 6–80+ years included in the National Health and Nutrition Examination Survey surveys for 2011–2012, 2015–2016, and 2017–2020 were analyzed and described.
Method
Analyses were primarily descriptive and relied on prevalence estimates, supported by logistic-regression analyses, and distribution-free medians. Otoscopic examinations were performed by trained technicians with review and supervision by a clinical audiologist. Effects of age, sex, and race/ethnicity were also examined.
Results
Overall, the prevalence of abnormal otoscopy was approximately 12%–15% with higher prevalence among males at most ages and for both sexes for age ≥ 60 years. Typically, 93% or more of the observed abnormalities were due to excessive or impacted cerumen, mainly the former. Logistic-regression analyses for the 6–19-year-olds found that only race/ethnicity affected the odds with non-Hispanic Blacks and Asians have higher odds for otoscopic abnormalities than non-Hispanic Whites. For 20- to 69-year-old adults, the odds of having abnormal otoscopic findings were about twice as high for males versus females, 60-year-olds versus 20-year-olds, and non-Hispanic Blacks versus non-Hispanic Whites. Overall, the effect of otoscopic abnormalities on the pure-tone averages for 500, 1000, 2000, and 4000 Hz and 3000, 4000, and 6000 Hz were negligible (< 3 dB), and this did not vary substantially with sex, race/ethnicity, or age.
Conclusion
Abnormal otoscopy, typically excessive cerumen, was observed in about 12%–15% of the individuals in this national sample, but the presence of such abnormalities had minimal effect on hearing sensitivity.
... Despite several studies on the effects of cerumen impaction and external canal occlusion [18,19] an exhaustive search of the Internet revealed not a single study in which the effect of cerumen impaction was documented in healthy [20] young patients having normal hearing. ...
Objective: To document change in hearing threshold due to cerumen impaction, in patients having normal hearing. Methodology: Initial pure tone audiometry (PTA) of patients with impacted cerumen in either one or both ears was performed. Frequencies 250, 500, 1000,2000,4000,6000 & 8000 Hertz (Hz) were tested. The consistency of cerumen i.e. wet and dry was documented; as was the amount of cerumen within the external auditory canal (EAC). After removal of the cerumen, PTA was repeated over the same frequencies and improvement if any, noted. Data of only those patients, who had normal hearing threshold after removal of cerumen, was consolidated. Results: Wet cerumen caused considerably more hearing loss in all grades of occlusion compared to dry cerumen. Conclusion: To standardise the results of further studies on this topic, a uniform classification of the grade of external ear canal occlusion needs to be developed.
... These results spotlight the need to physically examine the ear canal for impacted cerumen as a precondition to further assessment, as well as the need for training of the responsible healthcare professionals to undertake cerumen management. While nurses were reported to conduct otoscopy, referral to a specialist was typically made for cerumen removal [113]; however, in many jurisdictions, cerumen management is within the scope of practice for nurses who have completed certified training [51]. ...
Background
Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed.
Objective
To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs.
Methods
Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O’Malley’s scoping review and appraisal process was followed.
Results
There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs.
Conclusion
Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.
... A previous report by Roeser and Roland (1992) in the same age group documented a prevalence of 57%. Although in this study male athletes suffered more from earwax than female athletes, no previous relation between ear canal secretions and sex has been found neither, in the general population (Cipriani et al., 1990) nor in people with intellectual disability (Neuvel-Lakeman et al., 2009).Specific reasons for the increased prevalence of excessive or impacted earwax in the population with intellectual disability remain to be elucidated (Roeser & Ballachanda, 1997;Roland et al., 2008;Sugiura et al., 2014). Some possible explanations are the anatomical differences in the external ear canals (e.g., irregular shape and reduced diameter), a defective self-cleaning mechanism and physiological differences in cerumen production (i.e., higher amounts) (Crandell & Roeser, 1993;Neumann et al., 2006;Neuvel-Lakeman et al., 2009). ...
Background
Undetected ear and hearing problems negatively impact the quality of life of people with intellectual disability (ID).
Methods
This multicentre retrospective study describes the outcome of ten years of ear and hearing screening in athletes with ID in seven European countries. The screening was conducted by a trained team using a strictly standardised protocol.
Results
Of 15,363 screened athletes with ID, more than half (58.7%) needed referral for ear and/or hearing problems, ranging from 51.7% (<20years old) to 81.4% (≥60years old). The most commonly detected conditions were excessive/impacted earwax (40.3%), middle ear problems (30.1%), and hearing loss (27.0%), with significant differences between age groups and countries.
Discussion
This study demonstrates an increased risk of ear and hearing problems in people with intellectual disability as compared to the general population. Considering the unawareness and impact of these problems, it is highly recommended to organise systematic screening. Follow-up for diagnostic elaboration, therapeutic management, and long-term guidance should be provided.
... Another salient finding of the present study was that 15% of participants failed the otoscopic examination because of cerumen impaction. This finding was consistent with other studies (Aremu, Alabi, Segun-Busari, & Ogah, 2010;Sugiura et al., 2014). Reasons cited for the increased presence of impacted cerumen amongst the elderly include thinning of the surface epithelium, atrophy of the subcutaneous tissue, less production of oil and sweat by the ceruminous and sebaceous glands and lengthening of the hair in the ear canal all associated with the ageing of the skin in the ear canal (Sogebi et al., 2013). ...
Background: Age-Related Hearing Loss (ARHL) is the most widespread sensory disorder in the elderly. Poor audiological support within retirement homes is one of the fundamental issues impacting the Quality of Life (QoL).
Objectives: The objectives of this study were to: (1) Identify the presence of hearing impairment through a hearing screening test battery in a sample of elderly participants residing in three retirement homes. (2) Determine the psychological, communication-related and social impact of the hearing impairment on the QoL in a sample of elderly participants residing in retirement homes.
Method: A prospective cross-sectional research design with quantitative methods of data analysis was used to obtain data from 70 elderly participants (mean age = 79 years, 79% were female). Ten of them used hearing aids. Hearing screening was conducted using otoscopy, tympanometry and air conduction screening (500 Hz–4 kHz). The World Health Organization Quality of Life (WHOQoL) questionnaire was adapted and utilised for the present study.
Results: Findings revealed that 77% of the sample obtained a refer result from the hearing screening protocol indicating a high presence of hearing impairment. Twenty-nine per cent (n = 16) of the participants felt depressed, worried and anxious because of their hearing loss and 20% of participants felt unaccepted by their significant others as a result of their hearing impairment. Hearing difficulties were significantly associated with a reduced QoL (p = 0.045). Eight of the 10 participants who wore hearing aids reported an overall improvement in QoL since receiving and utilising their hearing aids and 20% (n = 2) of hearing aid users reported challenges with maintaining their hearing aids.
Conclusion: The findings of this study emphasised the need for an increased role for audiological services provided by audiologists within retirement homes, thereby contributing to an improved QoL.
... The combination of wet and dry cerumen was found in the population of the Middle East and Southeast Asia. Dry cerumen was common in the population of North China, Korea, and Japan (Sugiura et al., 2014). ...
Diseases of ear, nose, and throat (ENT) are common diseases in the world. The diseases are essential due to morbidities, which affect the physiological functions in the head and neck region. Cerumen impaction is the most common finding disease of ENT in children. The community service was done to find the distribution of ear, nose, and throat examination results of students in Letjen Jamin Ginting Junior High School, Berastagi, especially cerumen impaction which then were treated with cerumen removal. The community service also aimed to increase student's knowledge about ENT disease. The ENT examination was done to 188 students. The students with cerumen impaction were treated with cerumen removal. The students also educated about ENT disease to improve knowledge about ENT disease. Among 188 students, the number of male students was more than female with 98 students (52.1%), where 76 students (40.4%) were 14 years old. 150 students (79.8%) did not have any complaint about their ear, nose, and throat. Ear fullness was a common chief complaint from the students with 15 students (8.0%). Ear disease was a frequent disease with 44 students (47.3%) and cerumen impaction as the most common findings with 43 students (22.9%). In ENT disease education, the evaluation was done with the highest result was get by 8 students with 80% corrected answers. Ear disease had high prevalence with cerumen impaction as the most common findings of ENT examination.
... The management of patients with AD and hearing loss requires a multidisciplinary approach by audiologists, speech and language therapists, and neurologists and should include the immediate correction of any treatable cause of hearing impairment, such as the removal of earwax 71,72 , the use of hearing aids and other listening devices and specific strategies such as the employment of written communication and electronic devices, the reduction of background noise, the avoidance of subjective distressing sounds and the use of competing techniques for auditory hallucinations 73 . ...
Many research studies have focused on the relationship between hearing loss and Alzheimer’s Disease (AD). The mechanisms and causal relationship of hearing loss and AD remain partially unknown, and several theories have been proposed. The most accredited hypothesis is that hearing impairment may lead to sensory deprivation and social isolation that subsequently leads to dementia. Another hypothesis supports the role of hearing loss on cortical processing, by assigning to the auditory capacities a relevant role in the maintaining of cognitive function due to the anatomical correlation between the auditory and the memory areas . Additional theories hypothesize the presence of changes in brain structure, as for example brain atrophy, impacts on the audition capacities or that these changes may be correlated to hearing deficit and AD and that hearing loss may be an early symptom of dementia. The promising findings in recent research on the association between hearing loss and AD highlight the need for further research to a) permit an early detection of people with predisposition to AD, b) improve the quality of life in AD patients with hearing loss and c) possibly prevent the progression of the disease acting during the early stage of the disease on the hearing impairment.
In this review, the authors briefly discuss the current knowledge on the association between hearing loss and dementia, the clinical aspects of hearing loss in AD, the correct identification of auditory dysfunction in patients with Alzheimer and the management of patients with AD and hearing loss.
... A client who presents with what appears to be hearing loss (e.g., many instances of repetition, says "what" or "pardon me" repeatedly during an assessment) may in fact be experiencing hearing loss related to high levels of cerumen (ear wax), with research showing that cerumen management can lead to improvement in scores on cognitive testing (e.g., Moore, Voytas, Kowalski, & Maddens, 2002;Sugiura et al., 2014), and to significant improvement in hearing for 10 per cent of individuals presenting with hearing issues (Allen et al., 2003). Hearing loss can even prevent standardized neuropsychological tests from being administered properly (Lin et al., 2017) and is associated with poorer scores on standardized screening measures for cognitive loss (Lim & Loo, 2018). ...
RÉSUMÉ
La perte auditive représente une problématique répandue chez la population âgée. Cela peut poser des défis pour les neuropsychologues, étant donné que les méthodes d’intervention doivent être présentées oralement et donc entendues avec précision. Dans cette étude, le statut auditif de 20 clients (âge moyen= 71 ans) a été évalué au sein d’une clinique de neuropsychologie en milieu hospitalier et l’impact de cette évaluation sur la pratique des neuropsychologues a été étudié. Un assistant de recherche a administré un bref test de dépistage des troubles auditifs à chacun des clients. Nous avons demandé à quatre neuropsychologues de commenter le statut auditif de leurs clients avant et après leur avoir présenté les résultats des tests de dépistage. Le dépistage a révélé que la majorité des clients présentait au moins une perte auditive légère et que les neuropsychologues étaient relativement précis (60 %) dans leur estimation du statut auditif de leurs clients. Enfin, les neuropsychologues ont utilisé l’information sur le statut auditif de leurs clients en vue de les diriger vers des services en audiologie, ainsi que pour renseigner les clients et les familles sur la perte auditive et la communication.
... Moreover, large (Grade 3) EAE make it extremely difficult for the normal irrigation of the ear canal to cleanse the cerumen and exogenous debris from the canal [8,74,76]. The accumulated material then reduces both the sound transmission through the ear canal and the ability of the tympanic membrane to transmit the sound waves to the middle ear [77,78]. Accumulated cerumen and exogenous material in the canal is therefore a common cause of EAE related CHL in recent humans. ...
In the context of Middle and Late Pleistocene eastern Eurasian human crania, the external auditory exostoses (EAE) of the late archaic Xuchang 1 and 2 and the Xujiayao 15 early Late Pleistocene human temporal bones are described. Xujiayao 15 has small EAE (Grade 1), Xuchang 1 presents bilateral medium EAE (Grade 2), and Xuchang 2 exhibits bilaterally large EAE (Grade 3), especially on the right side. These cranial remains join the other eastern Eurasian later Pleistocene humans in providing frequencies of 61% (N = 18) and 58% (N = 12) respectively for archaic and early modern human samples. These values are near the upper limits of recent human frequencies, and they imply frequent aquatic exposure among these Pleistocene humans. In addition, the medial extents of the Xuchang 1 and 2 EAE would have impinged on their tympanic membranes, and the large EAE of Xuchang 2 would have resulted in cerumen impaction. Both effects would have produced conductive hearing loss, a serious impairment in a Pleistocene foraging context.
... High rates of cerumen impaction have been shown in geriatric (Mahoney, 1993) and intellectually impaired populations (Crandell and Roeser, 1993). Removal of cerumen impaction has been shown to improve hearing in healthy individuals (Subha and Raman, 2006), and cognition in geriatric patients with cognitive decline (Oron et al., 2011,Sugiura et al., 2014. Prevalence of cerumen impaction in the general adult population is about 5% (Roland et al., 2008). ...
... 14 In planning for care, a referral for wax removal is simple and may improve hearing substantially for the patient. 15 After wax removal, if problems continue then a hearing screening would be a logical next step. There are several options for quick, reliable and valid methods of hearing screening 14 that are summarized in Appendix B. Given that she has possible several months to live, she would be a candidate for audiological consultation. ...
The purpose of this article is to describe the unique needs of patients with hearing loss who are receiving hospice care. Hearing loss is the third most chronic condition in older adults and is often untreated. Such losses can interfere with critical communication exchanges that occur during admissions to hospice as well as during home or inpatient care. Three case scenarios are provided to illustrate these points. A comprehensive plan of options from screening to specific interventions is summarized. Options can be implemented to improve the overall communication for persons with hearing loss and their providers and family members. Improving communication may lead to improved quality of life and quality of care at end of life.
... Additionally, some at-risk patients who cannot identify or express symptoms of cerumen impaction should be assessed. Some at-risk patients include elderly adults with concerns of dementia 15,44 ; developmentally delayed or nonverbal patients with behavioral changes; and young children with fevers, parental concerns, or speech delay. The presence of cerumen in these patients can be considered impacted and removed. ...
Objective
This update of the 2008 American Academy of Otolaryngology—Head and Neck Surgery Foundation cerumen impaction clinical practice guideline provides evidence-based recommendations on managing cerumen impaction. Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. Changes from the prior guideline include a consumer added to the development group; new evidence (3 guidelines, 5 systematic reviews, and 6 randomized controlled trials); enhanced information on patient education and counseling; a new algorithm to clarify action statement relationships; expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences of opinion; an enhanced external review process to include public comment and journal peer review; and 3 new key action statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination of care.
Purpose
The primary purpose of this guideline is to help clinicians identify patients with cerumen impaction who may benefit from intervention and to promote evidence-based management. Another purpose of the guideline is to highlight needs and management options in special populations or in patients who have modifying factors. The guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction, and it applies to any setting in which cerumen impaction would be identified, monitored, or managed. The guideline does not apply to patients with cerumen impaction associated with the following conditions: dermatologic diseases of the ear canal; recurrent otitis externa; keratosis obturans; prior radiation therapy affecting the ear; previous tympanoplasty/myringoplasty, canal wall down mastoidectomy, or other surgery affecting the ear canal.
Key Action Statements
The panel made a strong recommendation that clinicians should treat, or refer to a clinician who can treat, cerumen impaction, defined as an accumulation of cerumen that is associated with symptoms, prevents needed assessment of the ear, or both. The panel made the following recommendations: (1) Clinicians should explain proper ear hygiene to prevent cerumen impaction when patients have an accumulation of cerumen. (2) Clinicians should diagnose cerumen impaction when an accumulation of cerumen, as seen on otoscopy, is associated with symptoms, prevents needed assessment of the ear, or both. (3) Clinicians should assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as ≥1 of the following: anticoagulant therapy, immunocompromised state, diabetes mellitus, prior radiation therapy to the head and neck, ear canal stenosis, exostoses, and nonintact tympanic membrane. (4) Clinicians should not routinely treat cerumen in patients who are asymptomatic and whose ears can be adequately examined. (5) Clinicians should identify patients with obstructing cerumen in the ear canal who may not be able to express symptoms (young children and cognitively impaired children and adults), and they should promptly evaluate the need for intervention. (6) Clinicians should perform otoscopy to detect the presence of cerumen in patients with hearing aids during a health care encounter. (7) Clinicians should treat, or refer to a clinician who can treat, the patient with cerumen impaction with an appropriate intervention, which may include ≥1 of the following: cerumenolytic agents, irrigation, or manual removal requiring instrumentation. (8) Clinicians should recommend against ear candling for treating or preventing cerumen impaction. (9) 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 use additional treatment. If full or partial symptoms persist despite resolution of impaction, the clinician should evaluate the patient for alternative diagnoses. (10) Finally, if initial management is unsuccessful, clinicians should refer patients with persistent cerumen impaction to clinicians who have specialized equipment and training to clean and evaluate ear canals and tympanic membranes. The panel offered the following as options: (1) Clinicians may use cerumenolytic agents (including water or saline solution) in the management of cerumen impaction. (2) Clinicians may use irrigation in the management of cerumen impaction. (3) Clinicians may use manual removal requiring instrumentation in the management of cerumen impaction. (4) Last, clinicians may educate/counsel patients with cerumen impaction or excessive cerumen regarding control measures.
... Pure tone audiometry materials were used to define the average hearing threshold, as in previous studies. 7,8 Japanese monosyllabic word lists, which have been used in previous studies, 9,10 were used for the speech discrimination tests. Maximum speech discrimination was assessed using analysis of variance (ANOVA) with repeated measures. ...
Transcranial direct current stimulation (tDCS) can alter cortical excitability, and has been effective in treating some neurological disorders. This case report describes the use of tDCS in a 13-year-old female who developed bilateral hearing impairment after brainstem encephalitis when she was 6 years old. Her auditory function was more impaired in her right ear than her left. Anodal stimulation (1 mA) was applied for 10 min to the left auditory cortex once per day for 4 consecutive days to improve her right ear speech discrimination score. Sustained and significant improvement in maximum speech discrimination was observed after the four tDCS treatments. To our knowledge, this is the first case report of improvement in speech discrimination after anodal stimulation of the auditory cortex. These results encourage further studies investigating the beneficial effects of tDCS in patients with hearing impairments.
Introduction
Impacted cerumen is a widespread reason that patients visit their health care providers. It effects approximately 2–6% of the general population and disproportionately impacts up to 65% of patients over 65. This study compared a new cerumen (earwax) removal product (Solution 1; EOS-002; a glycolic acid/bicarbonate formulation) versus two commercially available products (Solution 2 and Solution 3; both containing carbamide peroxide 6.5%) for their cerumenolytic activity in vitro.
Methods
Samples of human cerumen were placed in 10 x 75 mm polypropylene test tubes. Approximately 1 mL of each test solution was added and incubated at room temperature for 30 minutes. The vials were shaken at the 15- and 30-minute time points to simulate rinsing in a clinical setting. Breakdown of the cerumen was graded at 5-, 10-, 15-, and 30-minute time points in a masked manner on a 5-point scale (Grade 0 = no change; Grade 4 = complete disintegration).
Results
Significantly greater disintegration of the cerumen was observed in the samples exposed to EOS-002 at every time point (P < 0.0001). At 5 minutes, disintegration was observed in 39 out of 43 samples exposed to EOS-002, 0 out of 24 samples exposed to Solution 2, and 1 out of 19 samples exposed to Solution 3. Mean disintegration scores at 5, 10, 15, and 30 minutes were 1.65, 2.38, 2.95, and 3.24 for EOS-002; 0, 0, 0, and 0.2 for Solution 2; and 0.05, 0.13, 0.16, and 0.21 for Solution 3, respectively.
Discussion
EOS-002 exhibited a significantly greater ability to breakdown cerumen than the two other products. Disintegration of cerumen occurred with EOS-002 within 5 minutes in 91% (39/43) of the samples. Therefore, EOS-002 provides rapid disintegration of human cerumen in vitro.
The observed increase in cases of earwax plugs in patients, as well as the variety of methods of their removal using agents with different cerumenolysis activity, emphasize the need to search for the most modern and multifunctional otolaryngological preparations with proven efficacy. Based on the results of the analysis and generalization of literature sources on the treatment and prevention of ear sulfur plugs, presented in specialized publications in the Russian scientific eLibrary and scientific databases MedLine, Web of Science, Scopus, the need to optimize treatment methods and preventive measures has been identified. In this regard, it is recommended to widely use the preparation A-Cerumen Plus as one of the most progressive means. Further studies will increase the informativeness of the results of the dosage form with the active substance acylsarcosinate and sucrose laurate, in the realization of cerumenolysis issues.
Objective
To examine the prevalence of cerumen impaction in a nationally representative sample of the US population and the association of cerumen impaction with sociodemographic factors, hearing loss, and tinnitus.
Methods
The cohort included 14,230 individuals aged ≥12 years who completed otoscopy and audiometry in NHANES (2005–2016). Cerumen impaction (partial/complete) was determined by otoscopy. Hearing level was defined by speech‐frequency pure‐tone average (PTA). Multivariable regression analysis was performed to identify factors associated with cerumen impaction.
Results
The prevalence of any cerumen impaction was 18.6% [95% CI: 17.3%–19.9%] among individuals ≥12 years and 32.4% [29.9%–35.1%] among those ≥70 years. The prevalence of bilateral partial and complete cerumen impaction was 6.3% [5.6%–7.1%] and 1.2% [1.0%–1.9%], respectively. Any cerumen impaction was associated with male sex (OR 1.77 [1.5–2.1]), identifying as Black race (vs. Caucasian, OR: 1.78 [1.5–2.9]), lower level of education (OR: 0.84 [0.71–0.98]), and older age (OR: 1.02 [1.01–1.03]). After adjusting for sociodemographic and clinical factors, complete impaction was associated with increased PTA (right ear: β = 4.1 dB [2.4–5.8 dB], left ear: β = 1.9 dB [0.46–3.4 dB]), but not with tinnitus.
Conclusions
Cerumen impaction is highly prevalent in the US population, especially among older adults, and has disproportionate sociodemographic impacts. Complete impaction is associated with a small, statistically significant elevation in PTA, but there is no association with tinnitus. These findings emphasize the need to implement and disseminate best practices for ear hygiene and cerumen management broadly and equitably.
Level of Evidence
2B
Background
Emerging research indicates that video otoscopy can be used as a teaching tool to enhance students’ ability to identify outer and middle ear pathologies. However, there is little research on the perceptions of audiology students regarding their competence and confidence following video otoscopic training, and how they view the use of video otoscopy as a teaching tool. Therefore, this study aimed to determine undergraduate (UG) audiology students’ perceived competence and confidence in conducting otoscopy following training by video otoscopic examination.
Methods
A survey methodology with a cross sectional design was employed. An electronic questionnaire was distributed to all third and fourth year (senior) ( N = 79) UG audiology students using Survey Monkey. Ethical approval and permission from relevant stakeholders were obtained. Data were analysed using both descriptive and inferential statistics.
Results
60 % of the students felt competent in performing otoscopy, while 63.3 % felt less competent in interpreting otoscopic examination findings. 43.3 % felt they can confidently and competently identify outer ear pathologies. There was no association between the number of video otoscopic examinations performed and perceived competence or/and confidence. There was also no statistically significant relationship between year of study (e.g., third year versus fourth year) and perceived competence or/and confident ( p = 0.7131). Almost all (97 %) students felt that video otoscopic training should continue to be part of the clinical training as it helped them enhance their skills in performing otoscopy.
Conclusions
Current findings highlight the need to improve students’ practical training, incorporating pathologic ears into the curriculum. These findings also highlight the importance of supplementing practical training methodologies with changing technological advancements, particularly where tele-audiology opportunities may exist.
KernpuntenCerumen in de gehoorgang is pas een probleem als de cerumenprop de gehoorgang volledig afsluit en leidt tot gehoorklachten, pijn of een verstoppingsgevoel.Bij patiënten met een trommelvliesperforatie of met een radicaalholte kan het oor niet worden uitgespoten.Oorsmeer hoeft in principe alleen verwijderd te worden als het klachten geeft.Bij ouderen met een hoortoestel moet men extra alert zijn op de aanwezigheid van cerumen.Bij patiënten met een verminderd cognitief functioneren kan een cerumenprop de oorzaak van een plotselinge verslechtering zijn.In de meeste huisartsenpraktijken wordt oorsmeer verwijderd door uitspuiten met handwarm water (circa 37 °C). Cerumen in de gehoorgang is pas een probleem als de cerumenprop de gehoorgang volledig afsluit en leidt tot gehoorklachten, pijn of een verstoppingsgevoel. Bij patiënten met een trommelvliesperforatie of met een radicaalholte kan het oor niet worden uitgespoten. Oorsmeer hoeft in principe alleen verwijderd te worden als het klachten geeft. Bij ouderen met een hoortoestel moet men extra alert zijn op de aanwezigheid van cerumen. Bij patiënten met een verminderd cognitief functioneren kan een cerumenprop de oorzaak van een plotselinge verslechtering zijn. In de meeste huisartsenpraktijken wordt oorsmeer verwijderd door uitspuiten met handwarm water (circa 37 °C).
Cerumen of oorsmeer is het fysiologische afscheidingsproduct van tubulaire apocriene klieren gelegen in het buitenste derde gedeelte van de uitwendige gehoorgang. Cerumen wordt een probleem als de cerumenprop de uitwendige gehoorgang zodanig afsluit dat gehoorverlies, een gevoel van verstopping of andere klachten optreden.
Introduction: Impacted cerumen is a widespread reason that patients visit their health care providers. It effects approximately 2-6% of the general population and disproportionately impacts up to 65% of patients over 65. This study compared a new cerumen (earwax) removal product (Solution 1; EOS-002; a glycolic acid/bicarbonate formulation) versus two commercially available products (Solution 2 and Solution 3; both containing carbamide peroxide 6.5%) for their cerumenolytic activity in vitro . Methods: Samples of human cerumen were placed in 10 x 75 mm polypropylene test tubes. Approximately 1 mL of each test solution was added and incubated at room temperature for 30 minutes. The vials were shaken at the 15- and 30-minute time points to simulate rinsing in a clinical setting. Breakdown of the cerumen was graded at 5-, 10-, 15-, and 30-minute time points in a masked manner on a 5-point scale (Grade 0 = no change; Grade 4 = complete disintegration). Results: Significantly greater disintegration of the cerumen was observed in the samples exposed to EOS-002 at every time point ( P < 0.0001). At 5 minutes, disintegration was observed in 39 out of 43 samples exposed to EOS-002, 0 out of 24 samples exposed to Solution 2, and 1 out of 19 samples exposed to Solution 3. Mean disintegration scores at 5, 10, 15, and 30 minutes were 1.65, 2.38, 2.95, and 3.24 for EOS-002; 0, 0, 0, and 0.2 for Solution 2; and 0.05, 0.13, 0.16, and 0.21 for Solution 3, respectively. Discussion: EOS-002 exhibited a significantly greater ability to breakdown cerumen than the two other products. Disintegration of cerumen occurred with EOS-002 within 5 minutes in 91% (39/43) of the samples. Therefore, EOS-002 provides rapid disintegration of human cerumen in vitro .
The objective of this study was regarding sensory and cognitive interactions in older adults published since 2009, the approximate date of the most recent reviews on this topic. After an electronic database search of articles published in English since 2009 on measures of hearing and cognition or vision and cognition in older adults, a total of 437 articles were identified. Screening by title and abstract for appropriateness of topic and for articles presenting original research in peer-reviewed journals reduced the final number of articles reviewed to 34. These articles were qualitatively evaluated and synthesized with the existing knowledge base. Additional evidence has been obtained since 2009 associating declines in vision, hearing, or both with declines in cognition among older adults. The observed sensory-cognitive associations are generally stronger when more than one sensory domain is measured and when the sensory measures involve more than simple threshold sensitivity. Evidence continues to accumulate supporting a link between decline in sensory function and cognitive decline in older adults.
AimHearing loss is a risk factor for the progression of dementia. Cognitive improvement is occasionally found after removal of cerumen impaction. Because patients with dementia do not usually complain about cerumen impaction, detection methods are important. The present study aimed to investigate whether cerumen impaction is observable using brain magnetic resonance imaging.Methods
Participants were six patients whose hearing level improved 15 dB or more unilaterally or bilaterally after the removal of cerumen impaction. A radiologist who was blind to the impaction side and whether magnetic resonance imaging scans were taken before or after impaction removal classified cerumen impaction as positive, negative or unclear.ResultsThree ears classified as impaction positive and five ears classified as impaction negative corresponded accurately to the presence or absence of cerumen impaction. Among four ears classified as unclear, two did and two did not have cerumen impaction.Conclusion
Careful examination of the external ear canal on brain magnetic resonance imaging can be used to detect cerumen impaction. Geriatr Gerontol Int 2015; ●●: ●●–●●.
To determine the relationship between hearing loss and cognitive function as assessed with a standardized neurocognitive battery. We hypothesized a priori that greater hearing loss is associated with lower cognitive test scores on tests of memory and executive function.
A cross-sectional cohort of 347 participants ≥ 55 years in the Baltimore Longitudinal Study of Aging without mild cognitive impairment or dementia had audiometric and cognitive testing performed in 1990-1994. Hearing loss was defined by an average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear. Cognitive testing consisted of a standardized neurocognitive battery incorporating tests of mental status, memory, executive function, processing speed, and verbal function. Regression models were used to examine the association between hearing loss and cognition while adjusting for confounders.
Greater hearing loss was significantly associated with lower scores on measures of mental status (Mini-Mental State Exam), memory (Free Recall), and executive function (Stroop Mixed, Trail Making B). These results were robust to analyses accounting for potential confounders, nonlinear effects of age, and exclusion of individuals with severe hearing loss. The reduction in cognitive performance associated with a 25 dB hearing loss was equivalent to the reduction associated with an age difference of 6.8 years.
Hearing loss is independently associated with lower scores on tests of memory and executive function. Further research examining the longitudinal association of hearing loss with cognitive functioning is needed to confirm these cross-sectional findings.
To determine whether hearing loss is associated with incident all-cause dementia and Alzheimer disease (AD).
Prospective study of 639 individuals who underwent audiometric testing and were dementia free in 1990 to 1994. Hearing loss was defined by a pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear (normal, <25 dB [n = 455]; mild loss, 25-40 dB [n = 125]; moderate loss, 41-70 dB [n = 53]; and severe loss, >70 dB [n = 6]). Diagnosis of incident dementia was made by consensus diagnostic conference. Cox proportional hazards models were used to model time to incident dementia according to severity of hearing loss and were adjusted for age, sex, race, education, diabetes mellitus, smoking, and hypertension.
Baltimore Longitudinal Study of Aging.
Six hundred thirty-nine individuals aged 36 to 90 years.
Incident cases of all-cause dementia and AD until May 31, 2008.
During a median follow-up of 11.9 years, 58 cases of incident all-cause dementia were diagnosed, of which 37 cases were AD. The risk of incident all-cause dementia increased log linearly with the severity of baseline hearing loss (1.27 per 10-dB loss; 95% confidence interval, 1.06-1.50). Compared with normal hearing, the hazard ratio (95% confidence interval) for incident all-cause dementia was 1.89 (1.00-3.58) for mild hearing loss, 3.00 (1.43-6.30) for moderate hearing loss, and 4.94 (1.09-22.40) for severe hearing loss. The risk of incident AD also increased with baseline hearing loss (1.20 per 10 dB of hearing loss) but with a wider confidence interval (0.94-1.53).
Hearing loss is independently associated with incident all-cause dementia. Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.
Background:
Build-up of earwax is a common reason for attendance in primary care. Current practice for earwax removal generally involves the use of a softening agent, followed by irrigation of the ear if required. However, the safety and benefits of the different methods of removal are not known for certain.
Objectives:
To conduct evidence synthesis of the clinical effectiveness and cost-effectiveness of the interventions currently available for softening and/or removing earwax and any adverse events (AEs) associated with the interventions.
Data sources:
Eleven electronic resources were searched from inception to November 2008, including: The Cochrane Library; MEDLINE (OVID), PREMEDLINE In-Process & Other Non-Indexed Citations (OVID), EMBASE (OVID); and CINAHL.
Methods:
Two reviewers screened titles and abstracts for eligibility. Inclusion criteria were applied to the full text or retrieved papers and data were extracted by two reviewers using data extraction forms developed a priori. Any differences were resolved by discussion or by a third reviewer. Study criteria included: interventions - all methods of earwax removal available and combinations of these methods; participants - adults/children presenting requiring earwax removal; outcomes - measures of hearing, adequacy of clearance of wax, quality of life, time to recurrence or further treatment, AEs and measures of cost-effectiveness; design - randomised controlled trials (RCTs) and controlled clinical trials (CCTs) for clinical effectiveness, cohort studies for AEs and cost-effectiveness, and costing studies for cost-effectiveness. For the economic evaluation, a deterministic decision tree model was developed to evaluate three options: (1) the use of softeners followed by irrigation in primary care; (2) softeners followed by self-irrigation; and (3) a 'no treatment' option. Outcomes were assessed in terms of benefits to patients and costs incurred, with costs presented by exploratory cost-utility analysis.
Results:
Twenty-six clinical trials conducted in primary care (14 studies), secondary care (8 studies) or other care settings (4 studies), met the inclusion criteria for the review - 22 RCTs and 4 CCTs. The range of interventions included 16 different softeners, with or without irrigation, and in various different comparisons. Participants, outcomes, timing of intervention, follow-up and methodological quality varied between studies. On measures of wax clearance Cerumol, sodium bicarbonate, olive oil and water are all more effective than no treatment; triethanolamine polypeptide (TP) is better than olive oil; wet irrigation is better than dry irrigation; sodium bicarbonate drops followed by irrigation by nurse is more effective than sodium bicarbonate drops followed by self-irrigation; softening with TP and self-irrigation is more effective than self-irrigation only; and endoscopic de-waxing is better than microscopic de-waxing. AEs appeared to be minor and of limited extent. Resuts of the exploratory economic model found that softeners followed by self-irrigation were more likely to be cost-effective [24,433 pounds per quality-adjusted life-year (QALY)] than softeners followed by irrigation at primary care (32,130 pounds per QALY) when compared with no treatment. Comparison of the two active treatments showed that the additional gain associated with softeners followed by irrigation at primary care over softeners followed by self-irrigation was at a cost of 340,000 pounds per QALY. When compared over a lifetime horizon to the 'no treatment' option, the ICERs for softeners followed by self-irrigation and of softeners followed by irrigation at primary care were 24,450 pounds per QALY and 32,136 pounds per QALY, respectively.
Limitations:
The systematic review found limited good-quality evidence of the safety, benefits and costs of the different strategies, making it difficult to differentiate between the various methods for removing earwax and rendering the economic evaluation as speculative.
Conclusions:
Although softeners are effective, which specific softeners are most effective remains uncertain. Evidence on the effectiveness of methods of irrigation or mechanical removal was equivocal. Further research is required to improve the evidence base, such as a RCT incorporating an economic evaluation to assess the different ways of providing the service, the effectiveness of the different methods of removal and the acceptability of the different approaches to patients and practitioners.
Objective: To determine the relationship between hearing loss and cognitive function as assessed with a standardized neurocognitive battery. We hypothesized a priori that greater hearing loss is associated with lower cognitive test scores on tests of memory and executive function. Method: A cross-sectional cohort of 347 participants ≥55 years in the Baltimore Longitudinal Study of Aging without mild cognitive impairment or dementia had audiometric and cognitive testing performed in 1990–1994. Hearing loss was defined by an average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear. Cognitive testing consisted of a standardized neurocognitive battery incorporating tests of mental status, memory, executive function, processing speed, and verbal function. Regression models were used to examine the association between hearing loss and cognition while adjusting for confounders. Results: Greater hearing loss was significantly associated with lower scores on measures of mental status (Mini-Mental State Exam), memory (Free Recall), and executive function (Stroop Mixed, Trail Making B). These results were robust to analyses accounting for potential confounders, nonlinear effects of age, and exclusion of individuals with severe hearing loss. The reduction in cognitive performance associated with a 25 dB hearing loss was equivalent to the reduction associated with an age difference of 6.8 years. Conclusion: Hearing loss is independently associated with lower scores on tests of memory and executive function. Further research examining the longitudinal association of hearing loss with cognitive functioning is needed to confirm these cross-sectional findings.
Aim:
In this study we aimed to evaluate the frequency of cerumen impaction in Japanese elderly and clarify the associations between cerumen, cognitive function, and hearing impairment.
Methods:
The subjects enrolleded in this study were participants in the National Institute for Longevity Sciences, Longitudinal Study of Aging (NILS-LSA). The data of 792 community-dwelling participants aged 60 to 88 years old were collected. All had taken the Mini-Mental State Examination (MMSE) and had undergone pure tone audiometry (PTA) assessment and video recording of an otoscopic examination. We then analyzed associations between the incidence of the cerumen impaction of better-hearing ear, hearing level and MMSE scores using a general linear model.
Results:
Cerumen impaction of the better-hearing ear was observed in 10.7% of all participants. In participants with an MMSE score of less than 24, the frequency of cerumen impaction was 23.3%. Cerumen was significant associated with poorer hearing after adjustment for sex and age (p=0.0001). Cerumen impaction also showed a significant association with a low MMSE score after adjustment for sex, age, hearing level and education (p=0.02).
Conclusions:
The frequency of cerumen impaction in Japanese elderly was estimated to be approximately 10%. The existence of cerumen impaction was associated with poorer hearing level and lower MMSE score.
Cerumen impaction may affect hearing and decrease hearing acuity, thus decreasing cognitive functions among the elderly. The objective of this study was to compare the safety and the efficacy of three cerumenolytic agents and to assess the effect of cerumen removal on cognition. Thirty eight elderly subjects (mean age: 78 years, total 76 ears) were treated with either Auro®, Cerumol® or the newer CleanEars®, and the change in the degree of ear canal occlusion was examined after a week. In addition, a change in cognition following cerumen removal was evaluated using Raven's standard progressive matrices (RSPM) test. There was no difference regarding the eventual degree of occlusion between the three treatment groups. Only in the CleanEars® group a complete resolution of obstruction in both ears was achieved. A statistically significant difference between the RSPM score before and after the removal of cerumen was found. Using CleanEars® is as effective and safe as other agents and may be advantageous due to its spray application. Removal of cerumen significantly improves the well-being of elderly patients.
This retrospective study examined the etiology and treatment results for traumatic, conductive hearing loss in 22 patients who underwent surgery between 1998 and 2008 at Osaka Red Cross Hospital. All patients underwent computed tomography (CT) of the temporal bone preoperatively. The ear surgery comprised closure of the ruptured tympanic membranes and restoration of the sound-transmitting function of the ossicular chain. Their mean age was 30.3 years, and the average delay from injury until treatment was 6.0 years. Of the injuries due to foreign-body insertion, the most common cause was ear-pick injury. Incudostapedial disarticulation was the most common finding, which was diagnosed preoperatively using CT in seven cases and identified at surgery in 15 cases. Closure of the air-bone gap to within 10 and 20 dB was observed in 50.0 and 68.2% of the patients, respectively. The hearing threshold improved by 10 dB or more in 16 (72.7%) patients. If no improvement in hearing loss follows the absorption of hemotympanium or closure of an eardrum perforation, dislocation of the ossicular bones should be suspected. Ossicular reconstruction following trauma produces more stable and better hearing results, even after delayed treatment.
The purposes of this study were to estimate the prevalence of impacted cerumen in a population of hospitalized elderly patients, and to evaluate the effect of cerumen removal in reversing hearing impairment. The design was a pre-test/post-test static-group comparison. Over a 1-year period, a random sample (n = 226) was drawn every third day from daily admission lists of English-speaking patients aged 65 or older, admitted to non-intensive care units of one hospital. On either the second or third day of hospital stay, subjects were given a hearing test using an AudioScope and then their ear canals were examined for impacted cerumen. Ear canal irrigations were performed on those subjects with impacted cerumen. All subjects received a second hearing test. Results indicate that impacted cerumen is a common condition in the hospitalized elderly. Thirty-five per cent of the sample had impacted cerumen, 19.9% bilaterally and 15.0% unilaterally. Furthermore, removal of cerumen significantly improved hearing ability. Improved hearing scores were obtained in 75.0% of the ears after the impacted cerumen was removed, with subjects hearing from one to three more tones per ear on the second hearing test. An analysis of variance for repeated measures on hearing was computed to test for the effect of removing cerumen from individuals who had neither, one or both ears occluded. A significant interaction (F = 146.83, d.f. = 2/223, P less than 0.0001) between hearing tests and cerumen removal was found indicating that those with no occlusion had no change in hearing whereas both occluded groups increased with the greatest change for the bilateral group.(ABSTRACT TRUNCATED AT 250 WORDS)
With a steadily increasing proportion of the population in the geriatric age group, otolaryngologists are frequently confronted with conductive hearing losses in elderly patients. An evaluation of audiometric data from an out-patient audiology clinic over a six-month period revealed 13.4% of our geriatric patients presented with significant conductive components to their hearing loss. Advances in anesthetic management and medical therapy have broadened the indications for surgery in this age group. Recent evidence suggests that the results of surgery in the elderly patient are identical to those in younger age groups, and careful attention to associated medical problems can keep the complication rate at an acceptable minimum. In the appropriately selected elderly patient, surgical correction of a conductive hearing loss may well be the preferred option.
The incidence of occlusion of the external auditory canal due to impacted cerumen was determined for 44 mentally retarded subjects in comparison with 44 nonretarded subjects. Otoscopic data were taken by qualified personnel for both groups and subjected to statistical analysis. Results confirmed that retarded adolescents have a significantly higher incidence of occlusion of the external auditory canal due to impacted cerumen than do nonretarded adolescents. Routine otoscopic examinations should be performed on the former group to ameliorate loss of hearing due to impacted cerumen.
Hearing impairment has been hypothesized as contributing to symptoms of dementia. Data from a longitudinal study were analyzed to determine if auditory status predicted cognitive functional decline in senile dementia of the Alzheimer's type (SDAT). As part of a larger study, 156 consecutive SDAT outpatients had received a comprehensive medical evaluation including baseline screening for hearing impairment with the finger friction test and serial assessment of cognitive function with the Mini-Mental State examination. Age and cognitive function at entry to the study were greater among individuals with impaired hearing (N = 36) than with normal hearing (N = 120). The demographic profiles of the impaired and normal hearing groups were otherwise similar, as was the prevalence of depression. Intervening mortality rates were nearly identical. Decline in cognitive function one year later, however, was nearly twice as great in the impaired hearing group, a statistically significant difference (P less than .05, by one-tailed t test) even when controlled for age and initial cognitive function. These results, which need to be verified with sophisticated audiometric techniques, suggest that hearing impairment may be a prognostic indicator for subsequent cognitive dysfunction in SDAT. They are consistent with the hypothesized relationship between hearing impairment and dementia in SDAT as well as alternative hypotheses discussed in the text.
A major sequelae of impacted cerumen (earwax) is conductive hearing loss, which can be deleterious to linguistic, social, and intellectual development, particularly for individuals with mental retardation. The longitudinal incidence (12-year period) of excessive/impacted cerumen and related conductive hearing loss of 117 adults with mental retardation was examined. Results indicated a considerably higher incidence of excessive cerumen and cerumen impaction with associated conductive hearing loss in adults with mental retardation (28%) than in the general adult population (2% to 6%). Moreover, a strong propensity for recurrent cerumen impaction in the mentally retarded population was found. These findings were discussed in view of the management of cerumen impaction among individuals with mental retardation.
This investigation was performed to study the prevalence of cerumen impaction and evaluate its impact on hearing and cognition in elderly patients admitted to a skilled nursing facility (SNF).
Prospective clinical trial using a pretest-posttest design.
A 160-bed skilled nursing facility.
Twenty-nine English-speaking residents over the age of 65 who were new admissions to a SNF.
Participants with cerumen that occluded 50% or more of the external auditory canal had cerumen removed with a cerumenolytic agent and tepid water irrigation.
A standardized Folstein Mini-Mental Status Exam (MMSE)(1) and audiometric evaluation were administered to all participants before and after cerumen removal. Participants who did not have cerumen impaction served as controls. Hearing changes were scored as "+1" for an improvement, "0" for no change and "-1" for a loss at each frequency tested. Results were compared using 2-tailed paired t tests.
Nineteen participants (65.5%) had cerumen in at least one ear. Following cerumen removal, hearing improved in 80% of impacted ears compared with 3% of nonimpacted ears (P < 0.001). The average change in hearing score following cerumen removal was 0.26 +/- 0.50 compared with an average change of 0 +/- 0.16 in the controls (P < 0.001). The average change in MMSE score was 1.05 +/- 1.6 for participants who had cerumen removed compared with -0.30 +/- 0.95 for the controls (P < 0.01).
This study found a majority of residents admitted to the SNF had cerumen impaction. Evaluation of hearing and mental status following removal of cerumen resulted in a statistically significant improvement in hearing and cognition when compared with controls. Removal of cerumen is a relatively safe and easy procedure that can be done at minimal cost and provide a significant benefit to residents of a SNF.
Otitis externa (OE), also known as "swimmer's ear", is an inflammation or infection of the external auditory canal. Many risk factors have been identified, mainly excessive moisture in the canal from swimming.
To study the leading risk factors of otitis externa. Eighty-seven children aged 3.5-12 years (mean 68+/-6.5 months) who were diagnosed with otitis externa from December 1999 to March 2001 were studied for age, sex, cerumen cleaning habits, signs and symptoms. Findings were compared to an age-matched control group of 90 children without otitis externa.
Sixty-one children (70.1%) in the study group had their ears cleaned with a cotton-tip applicator (Q-tip) during the 10 days preceding the diagnosis of otitis externa. In the control group, only 31 (34%) used applicators routinely during the 10 days prior to diagnosis (P<0.001). Other risk factors for otitis externa were swimming in a pool (34%), wax removal (5.8%) and ventilation tubes (1.1%).
Use of a cotton-tip applicator to clean the ear seems to be the leading cause of otitis externa in children and should be avoided.
Cerumen: genetics, anthropology, physi-ology, and pathophysiology The Human Ear Canal
- Bb Ballachanda
Ballachanda BB. Cerumen: genetics, anthropology, physi-ology, and pathophysiology. In: Ballachanda BB, ed. The Human Ear Canal, 2nd edn. San Diego, CA: Plural Publish-ing, 2013; 141–170.
Cerumen: genetics, anthropology, physiology, and pathophysiology
- B B Ballachanda
Ballachanda BB. Cerumen: genetics, anthropology, physiology, and pathophysiology. In: Ballachanda BB, ed. The
Human Ear Canal, 2nd edn. San Diego, CA: Plural Publishing, 2013; 141-170.
Cerumen, hearing, and cognition in the elderly
- Moore