The Effect of Earwax Removal on Patient Management in the Pediatric Emergency Department

Cerumen obstructs the visualization of the tympanic membrane in up to 40% of children making it sometimes challenging to rule out the diagnosis of acute otitis media. Without it, children may go through unnecessary and painful investigation, that could have been spared. Our goal was to determine the rate at which removing the cerumen from blocking the view of the tympanic membrane could change the management of these patients in the pediatric emergency department.
We retrospectively investigated all charts of patients who undergone cerumen removal in the pediatric emergency department at a tertiary children hospital within the years 2018-2019 and analyzed the effect of the cerumen removal on their workup in their emergency visit. Out of 482 children who were referred to otolaryngologist from the emergency department 176 were included in the study group after having their cerumen removed. 73 of them had acute otitis media, 93 had a normal tympanic membrane and 10 had otitis externa. 21% of those with acute otitis media vs. 46% (p – 0.008) of those with a normal tympanic membrane had blood withdrawn as part of their workup in their emergency department visit. The rate of chest Xray also decreased significantly (16% vs. 30% p – 0.03). A non-statistically significant decrease was also noted in urine tests.
Conclusion: In children with a possible diagnosis of ear infection, cerumen removal changes the management of the patient in the emergency department and could avoid unnecessary workup which could save time, cost and suffer.