Cerumen, hearing, and cognition in the elderly

This investigation was performed to study the prevalence of cerumen impaction and evaluate its impact on hearing and cognition in elderly patients admitted to a skilled nursing facility (SNF).

Prospective clinical trial using a pretest-posttest design.

A 160-bed skilled nursing facility.

Twenty-nine English-speaking residents over the age of 65 who were new admissions to a SNF.

Participants with cerumen that occluded 50% or more of the external auditory canal had cerumen removed with a cerumenolytic agent and tepid water irrigation.

A standardized Folstein Mini-Mental Status Exam (MMSE)(1) and audiometric evaluation were administered to all participants before and after cerumen removal. Participants who did not have cerumen impaction served as controls. Hearing changes were scored as "+1" for an improvement, "0" for no change and "-1" for a loss at each frequency tested. Results were compared using 2-tailed paired t tests.

Nineteen participants (65.5%) had cerumen in at least one ear. Following cerumen removal, hearing improved in 80% of impacted ears compared with 3% of nonimpacted ears (P < 0.001). The average change in hearing score following cerumen removal was 0.26 +/- 0.50 compared with an average change of 0 +/- 0.16 in the controls (P < 0.001). The average change in MMSE score was 1.05 +/- 1.6 for participants who had cerumen removed compared with -0.30 +/- 0.95 for the controls (P < 0.01).

This study found a majority of residents admitted to the SNF had cerumen impaction. Evaluation of hearing and mental status following removal of cerumen resulted in a statistically significant improvement in hearing and cognition when compared with controls. Removal of cerumen is a relatively safe and easy procedure that can be done at minimal cost and provide a significant benefit to residents of a SNF.