Clinical practice guideline: Cerumen impaction
Clinical practice guideline: Cerumen impaction
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DOI：
10.1016/j.otohns.2008.06.026
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发表时间：
2008-09-01
影响因子：
3.4
通讯作者：
Wetmore, Stephen
中科院分区：
文献类型：
--
作者：
Roland, Peter S.;Smith, Timothy L.;Wetmore, Stephen
目的：该指南提供了关于处理耳垢嵌塞的循证建议，耳垢嵌塞定义为导致症状的耳垢积聚，阻止耳朵评估，或两者兼而有之。我们认识到，术语“嵌塞”表明耳道被耳垢完全阻塞，而我们对耳垢嵌塞的定义不需要完全阻塞。然而，耳垢嵌塞是首选术语，因为它在临床实践和已发表文献中一直用于描述症状性耳垢或妨碍评估的耳垢。本指南适用于所有有可能诊断和治疗耳垢嵌塞患者的临床医生。目的：本指南的主要目的是提高对耳垢嵌塞的诊断准确性，促进对耳垢嵌塞患者的适当干预，强调对特殊人群进行评估和干预的必要性，促进适当的治疗选择和结局评估，并加强预防耳垢嵌塞的咨询和教育。在创建这一指南的美国耳鼻咽喉头颈外科基金会学会选择了一个小组，代表听力学，家庭医学，老年医学，内科，护理，耳鼻咽喉头颈外科，儿科领域。结果：该小组提出了一个强烈的建议，1）临床医生应该治疗耳垢嵌塞，导致患者表达的症状或防止临床检查时，保证。专家组提出建议：1）当耳垢的积累与症状有关时，临床医生应该诊断耳垢嵌塞，或者阻止对耳朵进行必要的评估。（外耳道或鼓膜），或两者; 2）临床医生应通过病史和/或体格检查来评估耳垢嵌塞患者，以了解修改管理的因素，例如以下一项或多项：鼓膜不完整、耳道狭窄、外生骨疣、糖尿病、免疫功能低下状态或抗凝治疗; 3）临床医生应在医疗保健过程中检查佩戴助听器的患者是否存在耳垢嵌塞（检查频率高于每三个月一次）。然而，认为没有必要）; 4）临床医生应该用适当的干预来治疗患有耳垢嵌塞的患者，其可以包括以下中的一种或多种：耳垢溶解剂、冲洗或除冲洗之外的手动移除;以及5）临床医生应该在耳垢嵌塞的诊室治疗结束时评估患者并记录嵌塞的解决。如果嵌塞没有解决，临床医生应该规定额外的治疗。如果全部或部分症状持续，尽管解决嵌塞，应考虑替代诊断。该小组提供了一个选项，1）临床医生可以观察无症状的非嵌顿性耳垢患者，并且在需要评估时不会妨碍临床医生对患者进行充分评估; 2）临床医生可以区分并及时评估可能无法表达症状但出现耳垢阻塞耳道的患者的干预需求; 3）临床医生可以用耵聍溶解剂、冲洗或除冲洗外的手动清除治疗耵聍嵌塞患者; 4）临床医生可以就控制措施对耵聍嵌塞/过度耵聍患者进行教育/咨询。免责声明：本临床实践指南并非旨在作为治疗耵聍嵌塞的唯一指南来源。相反，它的目的是通过提供一个基于证据的决策策略框架来帮助临床医生。它并不打算取代临床判断或建立一个协议，为所有个人与这种情况下，和-可能不会提供唯一适当的方法来诊断和管理这个问题。(C)2008年美国耳鼻咽喉头颈外科学会基金会。All rights reserved.
OBJECTIVE: This guideline provides evidence-based recommendations on managing cerumen impaction, defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. We recognize that the term "impaction" suggests that the ear canal is completely obstructed with cerumen and that our definition of cerumen impaction does not require a complete obstruction. However, cerumen impaction is the preferred term since it is consistently used in clinical practice and in the published literature to describe symptomatic cerumen or cerumen that prevents assessment of the car. This guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction.PURPOSE: The primary purpose of this guideline is to improve diagnostic accuracy for cerumen impaction, promote appropriate intervention in patients with cerumen impaction, highlight the need for evaluation and intervention in special populations, promote appropriate therapeutic options with outcomes assessment, and improve counseling and education for prevention of cerumen impaction. In creating this guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of audiology, family medicine, geriatrics, internal medicine, nursing, otolaryngology-head and neck surgery, and pediatrics.RESULTS: The panel made a strong recommendation that 1) clinicians should treat cerumen impaction that causes symptoms expressed by the patient or prevents clinical examination when warranted. The panel made recommendations that 1) clinicians should diagnose cerumen impaction when an accumulation of cerumen is associated with symptoms, or prevents needed assessment of the ear (the external auditory canal or tympanic membrane), or both; 2) clinicians should assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as one or more of the following: nonintact tympanic membrane, ear canal stenosis, exostoses, diabetes mellitus, immunocompromised state, or anticoagulant therapy; 3) the clinician should examine patients with hearing aids for the presence of cerumen impaction during a healthcare encounter (examination more frequently than every three months. however, is not deemed necessary); 4) clinicians should treat the patient with cerumen impaction with an appropriate intervention, which may include one or more of the following: cerumenolytic agents, irrigation, or manual removal other than irrigation; and 5) clinicians should assess patients at the conclusion of in-office treatment of cerumen impaction and document the resolution of impaction. If the impaction is not resolved, the clinician should prescribe additional treatment. If full or partial symptoms persist despite resolution of impaction, alternative diagnoses should be considered. The panel offered as an option that 1) clinicians may observe patients with nonimpacted cerumen that is asymptomatic and does not prevent the clinician from adequately assessing the patient when an evaluation is needed; 2) clinicians may distinguish and promptly evaluate the need for intervention in the patient who may not be able to express symptoms but presents with cerumen obstructing the ear canal; 3) the clinician may treat the patient with cerumen impaction with cerumenolytic agents, irrigation, or manual removal other than irrigation and 4) clinicians may educate/counsel patients with cerumen impaction/excessive cerumen regarding control measures.DISCLAIMER: This clinical practice guideline is not intended as a sole source of guidance in managing cerumen impaction. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and-may not provide the only appropriate approach to diagnosing and managing this problem. (C) 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.