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Cerumen: A fundamental but neglected problem by pediatricians
Paola Marchisio1, Carlotta Pipolo2, Massimo Landi3
1Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Insights
Cerumen (earwax) is highly prevalent in children, affecting over 70%. Pediatricians rarely remove earwax, unlike specialists, potentially impacting diagnosis and treatment.
Area of Science:
- Pediatrics
- Otolaryngology
- Public Health
Background:
- Cerumen (earwax) impaction results from a failure of the ear canal's self-cleaning mechanism.
- Limited data exist on cerumen prevalence in pediatric populations.
- Understanding cerumen prevalence and removal practices is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To determine the prevalence of cerumen in a large pediatric population.
- To compare cerumen removal practices between pediatricians and otorhinolaryngologists.
- To highlight potential impacts on diagnosis, especially for acute otitis media.
Main Methods:
- A cross-sectional study of 819 children (1 month to 12 years) visiting clinics for respiratory infections or well-being checks.
- Data collected included cerumen presence, laterality, amount, presenting complaints, diagnosis, and physician type.
- Physician type (pediatrician vs. otorhinolaryngologist) and cerumen removal attempts were recorded.
Main Results:
- Cerumen was present in 72.5% of children, with higher prevalence in younger, African, or Asian children.
- Significant differences in cerumen removal rates were observed: pediatricians removed it in 28.8% of cases, while otorhinolaryngologists removed it in 91.0%.
- Pediatricians removed cerumen in only 31.6% of children diagnosed with acute otitis media, compared to 95.6% by otorhinolaryngologists.
Conclusions:
- Cerumen is highly prevalent in both healthy and sick children.
- Pediatricians demonstrate significantly lower rates of cerumen removal compared to otorhinolaryngologists.
- Educational interventions are needed to improve pediatricians' cerumen removal techniques and awareness, particularly for acute otitis media cases, to prevent misdiagnosis and inappropriate treatment.
Objectives:
Under physiological conditions, cerumen (Ce) is regularly extruded from the ear canal by a self-cleaning mechanism. Failure of this mechanism leads to excessive accumulation or impaction of Ce. Limited data are available concerning the prevalence of cerumen in healthy and sick infants and children. We assessed the prevalence of Ce in a large population of infants and children and compared the Ce removal attitudes of paediatricians (PEDs) and otorhinolaryngologists (ENTs).
Methods:
Children seen in November 2014 for acute respiratory infections, including suspected acute otitis media, or well-being visits, were enrolled. The following data were recorded: presence, laterality, and amount of Ce; presenting complaints and final diagnosis; attempt to remove Ce during the visit; and type of physician.
Results:
Among 819 children aged 1 month to 12 years, Ce was present in 594 (72.5%), of whom 478 (80.5%) had bilateral Ce, and 261 (43.9%) had Ce in a relevant amount (cerumen obstructing at least 50% of the ear canal). Presence of Ce was more common in younger and in African or Asian children. PEDs were less likely to remove cerumen than ENTs (28.8% vs 91.0%, p < 0.001) irrespective of age, gender, race and reason for visit. Ce was removed by PEDs in less than one-third of sick children with a final diagnosis of acute otitis media (AOM) (31.6%) compared with almost all the children by ENTs (95.6%, p < 0.001).
Conclusion:
Ce is highly prevalent in healthy and sick children but is quite neglected by PEDs. Educational programs to reinforce the importance of Ce removal and to improve the techniques for removal in case of suspected AOM should be implemented and rigorously evaluated in order to avoid incorrect diagnosis and erroneous treatments.
