Response to Paul and to Craig, RE: Cerumen Management

kerryo at dns.genesis.net kerryo at dns.genesis.net
Thu Feb 22 14:10:05 EST 1996


	In answer to Craig's question regarding suction, I use it occasionally.  One must be very cautious with this method in 
that there appears to be a greater chance of damaging the TM, canal wall, etc.  I typically use it after I have used irrigation and 
still can not get to a large plug of wax or when there is a lot of dead skin that is difficult to get ahold of with alligator forceps.  I 
used suction yesterday on a female patient with very small canal openings and wax deep in the canal.  Her complaint during the 
procedure was a common one,  "Oh, that is too loud!".  When the suction makes contact with the wax it does make a terrific 
noise in the canal.  My patients as a rule do not like it.  On tough wax cases, i.e. hard wax stuck to the canal wall or very close 
to the TM I will have them contact their local pharmacist and ask which wax softner they sell and recommend in the business.  
Use for the recommended amount of time and have the patient come back and 95%+ of the time you can either curette it out or 
wash it out. 

	In response to Paul's posting, reagrding the use of Afrin in a bleeding ear canal, I do not believe that in a scope of 
practice set by state guidelines allows us (as audiologists) to use topical medications for anything in or on the patient.  I think an 
individual would really be setting him/herself up for a hefty law suit if complications arose from the use of the medication that I put 
in the ear especially if that product was not sold to be used for that purpose.  When ever I have caused an ear to bleed I will try 
to ascertain the extent of the bleeding area, use sterile cotton to soak up the blood and determine if I need to send the patient 
on the an ENT to stop it.  Mind you at this point I use ENT's that are well aware of what I do and how I do it, so no hassels.  I 
have never had to send a patient out to an ENT with a bleeding ear.  I do is tell the patient that their ear canal is bleeding slightly 
which is not abnormal for some cases and sometimes show them on my video otoscope the scratch that I caused in the ear 
canal.  I rarely have this type of problem (bleeding) with my patients.  I have the patient come back in two or three days and in 
every case I can think of. the bleeding had stopped an a small scab had formed with no complications.

	Finally, doing anything where patient blood or bleeding is concerned brings up many other concerns that can be 
touched on by others, patients using medications that thin the blood, patients that are free bleeders, etc.

Sorry this is so long. I know there is a need for brevity but I felt these questiosn needed to be addressed.  

Kerry

Kerry Ormson, Ed.D.
Amarillo, Texas




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