Cerumen management is best practice

Did you know cerumen management has not always been in the scope of audiologists? Cerumen management was introduced into the scope of practice by the American Speech-Language-Hearing Association (ASHA) in 1992.¹ Many regulators quickly followed, supporting this induction into the scope of practice.

More recently, the American Academy of Otolaryngology-Head and Neck Surgery (AAO) created guidelines on best practice for cerumen impaction, which strongly recommends that allied healthcare professionals, such as audiologists and other HCPs, perform uncomplicated cerumen management.²

Subsequently, The World Health Organization (WHO) released their World Report on Hearing,³ highlighting cerumen management as one of the five significant gaps in the hearing care workforce.

Despite this, globally, many HCPs are either not permitted to perform cerumen management or do not feel competent. Even in countries where HCPs are permitted to perform cerumen management, not all do, and nearly half feel their educational background to perform cerumen management was inadequate.⁴

Let’s examine four big reasons why cerumen management is so important in the hearing care office.

1.  Cerumen impaction is common in the population we serve.

Prevalence of cerumen impaction ranges from 7% to 35% in the general population and as high as 57% in older adults.^2,3

Given the population that HCPs primarily serve, cerumen impaction is something you will regularly see in your practice. Not performing uncomplicated cerumen removal and referring to a General Practitioner, Nurse Practitioner, or Otolaryngologist overloads the medical system unnecessarily.

From 2009 to 2011, over 300,000 emergency room visits in the USA were due to cerumen impaction, making it the third highest billed procedure paid for by Medicare dollars. ⁵

2. Your clients trust you as the expert in ear care.

Clients who visit an HCP’s office often expect you to address cerumen for them, since they see the HCP as their ear care professional.

When a practitioner does not perform cerumen management, it can impact client trust, and they may view you as less skilled if you are not performing a role within your scope. Alternatively, managing their cerumen will build professional trust and enable you to address any other of their hearing care needs. 

3. Your testing (and results) require a clean ear canal.

Audiological testing and many other procedures we perform, including impression taking, hearing aid fitting, verification, etc., all require a clean ear canal free of debris and cerumen. When cerumen build-up is present, it can adversely affect results, can lead to decreased user satisfaction, and ultimately causes a disservice to the client and the profession. 

4. Cerumen management increases your clinic’s efficiency.

Having to delay an evaluation or hearing aid fitting due to impaction is incredibly inefficient for a clinic. Decreased efficiency can increase your costs, which can ultimately harm your business.

Additionally, well-managed cerumen impaction among your caseload means less hearing aid servicing will be required, increasing client satisfaction and clinic productivity.

Training resources available

Cerumen management is a procedure that requires skill, so proper training programs for cerumen management and ongoing education are essential. If you are interested in learning more about cerumen management training, check out Pacific Audiology Group‘s resources. 

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References:

1. American Speech‑Language‑Hearing Association. (2018). Scope of practice in audiology [Scope of Practice]. Available from www.asha.org/policy/.
2. Schwartz, S. R., Magit, A. E., Rosenfeld, R. M., Ballachanda, B. B., Hackell, J. M., Krouse, H. J., Lawlor, C. M., Lin, K., Parham, K., Stutz, D. R., Walsh, S., Woodson, E. A., Yanagisawa, K., & Cunningham, E. R., Jr (2017). Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) Executive Summary. Otolaryngology–head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery, 156(1), 14–29. https://doi.org/10.1177/0194599816678832
3. World Report on Hearing. Geneva: World Health Organization. Licence: CC BY-NC-SA 3.0 IGO. 2021. Available at: https://www.who.int/publications/i/item/world-report-on-hearing
4. Johnson, C. E., Danhauer, J. L., Rice, E. N., & Fisher, S. K. (2013). Survey of audiologists and cerumen management. American journal of audiology, 22(1), 2–13. https://doi.org/10.1044/1059-0889(2012/12-0032)
5. Yang EL, Macy TM, Wang KH, Durr ML. Economic and Demographic Characteristics of Cerumen Extraction Claims to Medicare. JAMA Otolaryngol Head Neck Surg. 2016;142(2):157–161. doi:10.1001/jamaoto.2015.3129