Cerumin X Lavagem auricular

Indications for removal — Cerumen removal is indicated for patients with symptoms due to cerumen (eg, hearing loss, earache, ear fullness, or itchiness) [1]. A systematic review, including observational studies and randomized trials, found that symptomatic patients with cerumen accumulation who underwent cerumen removal experienced improved hearing compared to those who were observed without treatment [1].
Cerumen removal should also be considered in patients who may not be able to express symptoms, such as young children and patients with cognitive impairment [15]. One prospective study of elderly nursing home patients found that patients with cerumen impaction had improved hearing and cognitive function following cerumen removal, compared to controls [4].
Patients who are asymptomatic should not have cerumen removed [1]. Many asymptomatic patients will clear cerumen without any intervention [16]. Furthermore, cerumen can serve as a protective layer for the skin of the ear canal, preventing against infection and trauma. Lastly, cerumen removal can result in rare adverse outcomes.

Indicações para método de irrigação com solução salina:
1. Otalgia.
2. Diminuição importante da audição.
3. Dificuldade de realizar otoscopia.
4. Desconforto auditivo.
5. Tinnitus (zumbido).
6. Tontura ou vertigem.
7. Tosse crônica.
Contraindicações para a remoção do cerume por meio do método de irrigação com solução salina:
1. Otite aguda.
2. História pregressa ou atual de perfuração timpânica.
3. História de cirurgia otológica.
4. Paciente não cooperativo.

There are three recommended therapeutic options: cerumenolytic agents, irrigation, and manual removal. There are no head-to-head trials comparing the individual methods for cerumen removal. Systematic reviews have not found superiority of one method over another. Selection of cerumen removal method should be based on provider experience. Availability of time, equipment (eg, irrigation system, curettes), and ancillary staff also may influence choice of removal method.
For providers with expertise and equipment (usually otolaryngologists), we suggest manual removal because this involves direct visualization during the removal process, minimizing damage to the ear canal skin and/or tympanic membrane. However, in the primary care setting where equipment and experience with manual removal may not be available, we suggest cerumenolytics rather than irrigation as no equipment is necessary and there is less risk of tympanic membrane perforation. If cerumenolytics fail, we suggest follow-up with irrigation.

Cerumenolytics — Cerumenolytics are safe to use in patients with no history of infections, perforations, or otologic surgery. Cerumenolytics should be avoided if tympanic membrane damage is suspected. If a patient has a history of drainage from the ear, ear pain, or frequent ear infections earlier in life, then the tympanic membrane may be impaired and cerumenolytics should not be employed.
In addition to cerumenolytics, patients with hard impaction or ear canal disease may require irrigation or manual removal under direct visualization with an otoscope or microscope in the office.

Irrigation — Irrigation is one of the most widely practiced forms of cerumen removal. Expert consensus supports irrigation as an effective and safe method for removing cerumen [1].

Manual removal — Manual removal is often quicker than cerumenolytics and irrigation, and does not expose the ear to moisture. Manual removal should be performed by clinicians with adequate experience and appropriate equipment. Manual removal requires adequate visualization, usually with an otoscope or binocular microscope.