REFERRED CERUMEN MANAGEMENT
Upon VO examination, the patient presented with a +3 cerumen accumulation bilaterally and was referred for ENT cerumenectomy. Subsequent pre-impression status: +1 AD and 0 AS
REFERRED EAC OBSTRUCTION
The patient has been referred to you for ENT consultation. Video otoscopy verifies a +3 accumulation of cerumen, desquamation and malodorous external otic effusion.
DIRECT CERUMEN MANAGEMENT
The patient presented on VO with a bilateral cerumen accumulation, +3 AD and +1 AS. VO curettage was applied to AD with cerumen status improved to 0 in the aided ear. No action taken, AS.
O:Cerumen entirely absent or present in a small amount, insufficient to limit audiological access to the ear in any way. Tympanic membrane may be fully visualized, including the annulus. Removal not indicated. EXAMPLES: 0/A(18k) | 0/B(17k) | 0/C(18k)
+1: Non-occlusive minor amount present but significant by location and texture to interfere with probe tube microphone measurements but not with ear-insert measurements [e.g. immittance or OAE] or hearing instrument use. Impact on impression-taking accuracy will vary with hearing instrument morphology; i.e. non-occluding full concha ITE vs. deep canal CIC. Tympanic membrane may be essentially visualized. Removal optional. EXAMPLES:+1/A(21k) | +1/B(22k) | +1/C(22k) | +1/D(18k)
+2: Non-occlusive moderate amount present; likely to interfere with probe tube and ear-insert transducer measurements, hearing aid use, to dimensionally distort or inhibit impression-taking with the possibility of subsequent impaction. Tympanic membrane view may be partially obscured. Removal advised. EXAMPLES:+2/A(25k) | +2/B(23k) | +2/C(21k) | +2/D(21k)
+3: Occlusive major amount present; likely to interfere with insert and circumaural hearing testing, may add a conductive overlay; obstruct hearing aid receiver and vent, reducing effective gain and output. Tympanic membrane not visualized. Removal essential. EXAMPLES:+3/A(25k) | +3/B(27k) | +3/C(27k) | +3/D(17k) | +3/E(19k) | +3F(18k)