There are a growing number of cerumen management tools and instruments available on the market today, which might be overwhelming if you are a new provider. Since we run an online training program in cerumen management, clinicians who complete it naturally come to us for advice on what cerumen tools they should start with, or they want to learn more about equipment that we feature in the course. Some even just want to know what is “the best”. So here is our opinion on the matter, which is of course subjective, but we will stress that neither of us nor any colleagues receive sponsorship or any other financial incentive for featuring these or any other products.
We believe that gaining fundamental knowledge of all three accepted methods of cerumen removal (irrigation, microsuction, and instrumentation) offers an ideal foundation to build upon. Having this knowledge not only builds confidence, reduces risk, and improves productivity, but it also gives you the best chance for success when removing impacted cerumen. A practitioner must not rely on a single tool here, so we will provide you with an equipment top pick for each method and will also include lighting and even furniture. The main considerations we use, aside from the obvious one (i.e., is it safe AND effective?), are things like cost-effectiveness, infection control compliance, availability, and portability.
Cerumen Irrigation: Our Must-Have Tool
For irrigation, our top pick is the OtoClear Spray Wash System from Bionix. This is the most straightforward irrigation tool. It meets our criteria above, and here is why we like it:
(1) It has a built-in temperature gauge that ensures the water is the correct temperature for irrigation, which is body temperature, to avoid stimulating the semicircular canals and causing vertigo.
(2) It is operated with a hand pump. We prefer a manual hand pump to a pre-pressurized pump. It reduces clinical risk by having less pressurized water, is less startling to the client, and allows you to vary pressure and flow manually.
(3) The tip is diffuse. For irrigation, a critical element is that the water is not directed at the tympanic membrane. The single-use Ototip diffuses the water spray automatically into three directions; this keeps the tympanic membrane safe and assists in dislodging cerumen as the streams are coming from different directions.
Cerumen Microsuction: Our Must-Have Tools
For microsuction, our top pick is the Baron tip in size 7. Surgical-grade stainless steel tools intimidate some, but after some practice adjusting to head-worn lighting and magnification to see where you are working, these really can’t be beaten. Impeccable hygienic reprocessing standards need to be followed!
A runner-up is the Bionix Lighted Suction Tool. This is worth checking out, especially for the new or travelling clinician. This single-use device provides magnification and illumination within the instrument, making it an easy all-in-one product.
Cerumen Instrumentation: Our Must-Have Tool
For curettage, we have one clear top pick – the Bionix Lighted Flex Loop – for the following reasons:
(1) It offers built-in lighting and an optional magnifier.
(2) The tip is highly versatile, giving flexibility and enough rigidity with a nice tip angle. This tool is a must-have in your cerumen management kit. We frequently use it to clean up after another procedure like irrigation.
Cerumen Lighting: Our Must-Have Tools
Whether you require head-worn or handheld lighting, we have different recommendations. For a handheld otoscope, we recommend using a video otoscope, which is helpful for patient counselling and before/after photos. The Firefly DE550 is a good cost-effective wireless option, while the MedRx USB Video Otoscope is slim and has excellent resolution, and is also NOAH and Blueprint compatible. For a standard handheld otoscope, the Welsh Allyn Macroview Otoscope is my recommendation and they even offer a digital version now. This is a powerful otoscope with a rechargeable handle. If you’re performing microsuction or using non-lighted curettes, then head-worn lighting and magnification are required. Heine makes a product called the LightLoupe2 that is a good option here.
Cerumen Management Furniture: Our Must-Have
The room you perform cerumen management in needs to have specific furniture components such as fixed seating for your patient, a sink (especially for irrigation), and eye-ear level seating for the clinician. Fortunately, most hearing care clinics are equipped with this setup already. In audiology clinics, a “cerumen management cart,” containing all the cerumen management-specific equipment, can be a useful piece of furniture to wheel from room to room where you perform cerumen management. This avoids having to duplicate the equipment in multiple rooms. A full ENT cart with suction and storage is cost-prohibitive for most, so what I recommend here is the IKEA RÅSKOG. It has three levels and can be outfitted with equipment for all three methods of cerumen removal, plus your lighting.
Equipment To Keep an Eye On
There are some exciting new advances available now, and some others we have confidential knowledge of that we cannot talk about just yet. Here are a few available today that you do not want to miss!
(1) The Vorotek O-Scope is a head-worn otoscope, and although it does not offer the same level of magnification as a head loupe, it is unique in that it provides binocular vision, allowing great depth perception.
(2) The Earway Pro from Earways Medical tool can address simple, uncomplicated removal without the need for lighting or magnification, in a straightforward manner. It takes a little training and practice to get used to but can be highly effective!
(3) The Otoset from start-up med tech company SafKan Health is an innovative new irrigation device. It is uniquely able to complete hands-off bilateral irrigation in under a minute. We had a chance to experience it firsthand ourselves and were extremely impressed.
If you would like to become an expert in cerumen management, sign up for our comprehensive online program today!