Research Gaps - Cerumen Impaction
While there is a body of literature from which these guidelines were drawn, significant gaps in our knowledge about cerumen impaction and its management remain. The guideline committee identified several areas where further research would improve the ability of clinicians to optimally manage patients.
- Establish a universal definition of cerumen impaction to make comparisons of management strategies more meaningful.
- Assess the natural history of cerumen impactions by performing observational studies in untreated populations, including the elderly, children and developmentally delayed patients.
- Conduct studies assessing the role of preventive measures, such as emollients and ear hygiene, on the development of cerumen impactions.
- Assess the various methods of cerumen removal, either as single interventions or combined interventions, through well designed, randomized, large scale controlled trials.
- Determine the efficacy of manual removal of cerumen through prospective studies.
- Assess comparative impact of different cerumenolytic agents through well-designed clinical trials.
- Evaluate the efficacy of prophylactic topical antibiotics in preventing otitis externa when local trauma occurs during cerumen removal.
- Conduct a financial analysis comparing the various methods of cerumen management
- Determine the relative efficacy of cerumenolytic agents and irrigation for adult, elderly, pediatric and patients at high risk for complications related to cerumen removal due to underlying conditions (i.e. diabetes, coagulopathies)
- Evaluate the impact of cerumen removal on the resolution of symptoms such as itching, hearing loss, pain, fullness, tinnitus, or vertigo through prospective clinical studies.
- Establish that studies evaluating cerumen removal should document adverse events
- Assess variation in outcomes for cerumen removal relative to the type of health care provider managing the patient (i.e. nurse, physician assistant, physician, medical assistant)
- Conduct financial analyses of the relative costs for cerumen management when performed by different types of health care providers.