There are a growing number of cerumen management instruments and tech options today, which might be overwhelming if you are a new provider. Since we run an online training program in cerumen management, clinicians naturally come to us for advice on what cerumen tools they should start with, and for more details about the equipment we feature in our course. Below are our top picks for tried-and-true cerumen management tools and some additional information about new tech available today or coming soon! Please note that neither of us nor any colleagues received sponsorship or any other financial incentive for featuring these or any other products.
We believe that gaining fundamental knowledge of all three accepted methods of cerumen removal (irrigation, microsuction, and instrumentation) offers an ideal foundation to build upon. Having this knowledge not only builds confidence, reduces risk, and improves productivity, but it also gives you the best chance for success when removing impacted cerumen. A practitioner must not rely on a single tool here, so we will provide you with an equipment top pick for each method and will also include lighting and even furniture. The main considerations we use, aside from the obvious one (i.e., is it safe AND effective?), are things like cost effectiveness, infection control compliance, availability, and portability.
Irrigation
For irrigation, our top pick is the OtoClear Spray Wash System from Bionix. This is the most straightforward irrigation tool. It meets our criteria above, and here is why we like it:
- It has a built-in temperature gauge that ensures the water is the correct temperature for irrigation, which is body temperature, to avoid stimulating the semicircular canals and causing vertigo.
- It is operated with a hand pump. We prefer a manual hand pump to a pre-pressurized pump. It reduces clinical risk by having less pressurized water, is less startling to the client, and allows you to vary pressure and flow manually.
- The tip is diffuse. For irrigation, a critical element is that the water is not directed at the tympanic membrane. The single-use Ototip diffuses the water spray automatically into three directions; this keeps the tympanic membrane safe and assists in dislodging cerumen as the streams are coming from different directions.
Microsuction
For microsuction, our top pick is the Baron tip in size 7. Surgical grade stainless steel tools intimidate some, but after some practice adjusting to head-worn lighting and magnification to see where you are working, these really can’t be beat. Impeccable hygienic reprocessing standards need to be followed!
A runner-up is the Bionix Lighted Suction Tool. This is worth checking out, especially for the new or traveling clinician. This single-use device provides magnification and illumination within the instrument, making it an easy all-in-one product.
Instrumentation
For curettage, we have one clear top pick - the Bionix Lighted Flex Loop - for the following reasons:
- It offers built-in lighting and an optional magnifier.
- The tip is highly versatile, giving flexibility and enough rigidity with a nice tip angle. This tool is a must-have in your cerumen management kit. We frequently use it to clean up after another procedure like irrigation.
Lighting
Whether you require head-worn or handheld lighting, we have different recommendations. For a handheld otoscope, we recommend using a video otoscope, which is helpful for patient counseling and before/after photos. The Firefly DE550 is a good cost-effective wireless option, while the MedRx USB Video Otoscope is slim and has excellent resolution, and is also NOAH and Blueprint compatible. For a standard handheld otoscope, the Welch Allyn Macroview Otoscope is my recommendation and they even offer a digital version now. This is a powerful otoscope with a rechargeable handle. If you’re performing microsuction or using non-lighted curettes, then head-worn lighting and magnification are required. Heine makes a product called the LightLoupe2 that is a good option here.
Furniture
The room you perform cerumen management in needs to have specific furniture components such as fixed seating for your patient, a sink (especially for irrigation), and eye-ear level seating for the clinician. Fortunately, most hearing care clinics are equipped with this setup already. In audiology clinics, a "cerumen management cart," containing all the cerumen management specific equipment, can be a useful piece of furniture to wheel from room to room where you perform cerumen management. This avoids having to duplicate the equipment in multiple rooms. A full ENT cart with suction and storage is cost prohibitive for most, so what I recommend here is the IKEA RÅSKOG. It has three levels and can be outfitted with equipment for all three methods of cerumen removal, plus your lighting.
Equipment To Keep an Eye On
There are some exciting new advances available now, and some others we have confidential knowledge of that we cannot talk about just yet. Here are a few available today that you do not want to miss!
- The Vorotek O-Scope is a head-worn otoscope, and although it does not offer the same level magnification as a head loupe, it is unique in that it provides binocular vision, allowing great depth perception.
- The Earway Pro from Earways Medical tool can address simple, uncomplicated removal without the need for lighting or magnification, in a straightforward manner. It takes a little training and practice to get used to, but can be highly effective!
- The Otoset from start-up med tech company SafKan Health is an innovative new irrigation device. It is uniquely able to complete a hands-off bilateral irrigation in under a minute. We had a chance to experience it firsthand on ourselves and were extremely impressed.
If you would like to become an expert in cerumen management, sign up for our comprehensive online program today!
About the Authors:
Amy Trusler, AuD
Registered Audiologist, Registered Hearing Instrument Practitioner, Certified in Cerumen Management (CSHBC)
Previously a clinic owner in her hometown of Squamish, British Columbia, Amy has worked closely with First Nations Communities initiating a Rural Audiology Care program. She has provided educational mentorship to several students and has given community lectures and presentations in audiology. Amy has designed courses in audiology for clients and audiologists alike. Amy sold her practice in 2019 and followed her calling to work on modernizing continuing education in hearing healthcare and to help others learn audiology online. She has since developed several new skills including web development!
Kris Hewitt, BC-HIS
Registered Hearing Instrument Practitioner, Certified in Cerumen Management (CSHBC)
Kris has diverse experience within wholesale, training, clinic retail, as well as private practice ownership. Prior to co-founding Pacific Audiology Group, Kris worked with Siemens Hearing Instruments before becoming the business development manager for Demant (Oticon) for several years. Kris later purchased his own private practice, completed a renovation, re-brand, and upgrade to a digital and paperless database, and operated it prior to selling in 2019. Kris is a natural teacher, and he brings a unique perspective to the business side of hearing healthcare and understands what it takes to be successful in private practice.