The Battle Against Cerumen Buildup: Factors Related To Impaction
Overview
This study aimed to assess the prevalence of cerumen impaction in a nationally representative sample of the US population and its association with various sociodemographic factors, hearing loss, and tinnitus.
Using data from NHANES (2005–2016), involving 14,230 individuals aged 12 years and above, cerumen impaction (partial or complete) was determined through otoscopy, while hearing levels were assessed by speech-frequency pure-tone average (PTA).
The findings revealed that the prevalence of any cerumen impaction was 18.6% among individuals aged 12 years and older, with a notably higher prevalence of 32.4% among those aged 70 years and above. Bilateral partial and complete cerumen impaction rates were 6.3% and 1.2%, respectively. Sociodemographic factors such as male sex, Black race, lower education level, and older age were associated with a higher likelihood of cerumen impaction.
After adjusting for sociodemographic and clinical factors, complete cerumen impaction was linked with a slight but statistically significant elevation in PTA, indicating a potential impact on hearing. However, there was no significant association between cerumen impaction and tinnitus.
In conclusion, cerumen impaction is prevalent in the US population, particularly among older adults, and demonstrates significant sociodemographic disparities. While complete impaction appears to have a minor effect on hearing, no association was found with tinnitus. These findings underscore the importance of implementing and disseminating best practices for ear hygiene and cerumen management across diverse populations to mitigate the impact of cerumen impaction effectively.
Introduction
Cerumen, commonly known as earwax, is a natural substance found in the ear canal, serving to lubricate, clean, and protect the ear. However, when the self-cleaning mechanisms of the ear canal are compromised, excessive cerumen buildup, known as cerumen impaction, can occur, leading to symptoms such as aural fullness, pain, itching, and hearing loss. This condition presents a significant healthcare burden, with millions of medical office visits annually for cerumen-related issues.
To guide evidence-based practice, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) published clinical practice guidelines on cerumen impaction. Previous studies have shown a prevalence of 10%–12% in adults aged 20–69 years, but data on other age groups and associated factors are limited.
This study aimed to fill this gap by estimating the prevalence of cerumen impaction and identifying associated demographic and clinical factors in a national sample of individuals aged 12 years and older in the United States. Additionally, the study sought to examine the relationship between cerumen impaction, tinnitus, and audiometrically measured hearing loss to better inform clinical practice and patient counseling.
Understanding these relationships can aid in the clinical evaluation of patients presenting with symptoms related to cerumen impaction, allowing for more targeted interventions and improved patient outcomes.
Method
The study conducted a thorough analysis utilizing data from the National Health and Nutrition Examination Survey (NHANES), a renowned source encompassing a diverse sample of individuals across different age groups in the United States. This dataset, spanning from 2005 to 2016, provided a comprehensive view of various health parameters, making it ideal for investigating the prevalence and determinants of cerumen impaction.
Cerumen impaction, characterized by the accumulation of earwax causing either partial or complete blockage of the ear canal, served as the primary outcome measure. To ascertain cerumen impaction, trained NHANES examiners conducted otoscopic examinations to assess the condition of the ear canal and tympanic membrane. The study defined partial impaction as a condition where less than half of the tympanic membrane was visible due to cerumen accumulation, while complete impaction referred to a complete blockage of the tympanic membrane by cerumen. These definitions were in line with established NHANES protocols and guidelines, ensuring consistency and accuracy in assessment.
In addition to cerumen impaction, the study examined various covariates to elucidate the factors associated with this condition. Demographic factors such as sex, race/ethnicity, education level, household income, and insurance status were assessed for their potential impact on cerumen impaction prevalence. Moreover, medical history variables including diabetes, hypertension, cardiovascular disease, stroke, and smoking status were considered, recognizing their potential association with ear health.
Body mass index (BMI) was also incorporated into the analysis, categorized according to WHO weight classes, to explore any potential correlation between weight status and cerumen impaction. Furthermore, the study investigated the role of occupational and recreational noise exposure, hearing protection use, and tinnitus in relation to cerumen impaction, recognizing the interconnectedness of these factors with ear health outcomes.
Sensitivity analysis was conducted to ensure the robustness of the findings, with additional exploration of sociodemographic factors associated with missing data on hearing protection use. This analysis provided valuable insights into potential biases and helped strengthen the validity of the study findings.
Overall, the study’s meticulous approach to data analysis and comprehensive exploration of covariates contributed to a nuanced understanding of the prevalence and determinants of cerumen impaction in the NHANES cohort.
Statistical Analysis
The study employed rigorous methodology to analyze a comprehensive dataset, ensuring robust and generalizable results applicable to the broader US population. Sample weighting, in accordance with established guidelines from the National Center for Health Statistics, was utilized to enhance the representativeness of the findings. Unweighted data, presented in Table 1, provided a detailed overview of the study cohort’s characteristics, facilitating descriptive analysis.
Statistical comparisons of baseline characteristics employed Pearson’s chi-square test for categorical variables and the Student t-test for continuous variables. Univariable and multivariable logistic regression analyses were conducted to identify factors associated with cerumen impaction, with adjustments made for various demographic and clinical variables such as age, sex, race/ethnicity, education, income, insurance, smoking status, BMI, diabetes mellitus (DM), and hypertension (HTN).
In multivariable regression analyses exploring the association of cerumen impaction with hearing loss and tinnitus, additional covariates such as occupational/recreational noise exposure and hearing protection were included when significantly associated with the outcomes. Collinearity diagnostics were meticulously performed to address potential multicollinearity issues, with a predefined variance inflation factor (VIF) threshold of >2.5 used as a criterion for problematic correlation among variables.
Exclusion of certain variables, such as a history of stroke and cardiovascular disease, was warranted due to elevated VIF values. Subsequent collinearity diagnostics confirmed the absence of collinearity among remaining covariates post-exclusion.
Linear regression analysis was employed to investigate the association between cerumen impaction and pure-tone audiometry (PTA), disaggregated by ears. Logistic regression analysis was utilized to assess the relationship between different levels of cerumen impaction (unilateral partial, bilateral partial, unilateral complete, and bilateral complete impaction) and tinnitus.
Statistical significance was predetermined at p < .05, two-tailed, ensuring rigorous evaluation of associations. All analyses were conducted using Stata (version 16.1; StataCorp, College Station, TX), a widely recognized statistical software, further enhancing the study’s credibility and reliability.
Result
The study investigated the prevalence and factors associated with cerumen impaction in individuals aged 12 years and older in the United States. After applying sampling weights, the estimated overall prevalence of cerumen impaction was found to be 18.6% for individuals aged 12 and above and 32.4% for older adults aged 70 and above. The prevalence of partial cerumen impaction was consistently higher than that of complete impaction across all analyzed subgroups, regardless of whether the impaction was unilateral or bilateral.
Several demographic factors were identified as significantly associated with cerumen impaction. Older age, male sex, Black race, lower education level, and being enrolled in Medicare/Medicaid insurance were independently correlated with a higher likelihood of cerumen impaction. However, medical conditions such as diabetes mellitus (DM) and hypertension (HTN) were not found to be associated with cerumen impaction.
Individuals with complete cerumen impaction exhibited higher pure-tone averages (PTA) in both ears compared to those without impaction. However, partial cerumen impaction did not significantly affect PTA when analyzed against the no impaction states. Additionally, neither unilateral nor bilateral partial or complete cerumen impaction showed an association with the presence of tinnitus.
These findings shed light on the prevalence and demographic factors related to cerumen impaction, highlighting the need for targeted interventions and management strategies to address this common condition. Further research is warranted to explore the clinical significance of elevated PTA in individuals with complete cerumen impaction and to better understand the relationship between cerumen impaction and tinnitus.
Conclusion
The study investigated the prevalence of cerumen impaction among individuals aged 12 and older in the United States, revealing a significant burden, particularly among older adults. Notably, the prevalence was higher than previous regional studies, indicating a potentially underestimated public health issue. Cerumen impaction was associated with various sociodemographic factors, including older age, male sex, Black race, public insurance, and lower education, highlighting the intersection between cerumen impaction and social determinants of health.
The findings underscored the clinical implications of cerumen impaction, particularly for optimizing hearing thresholds and alleviating associated symptoms. Addressing cerumen impaction, especially among older adults, was deemed essential, with recommendations for routine monitoring and appropriate cleaning when necessary.
Several sociodemographic patterns emerged, with males, older individuals, and Black participants exhibiting higher likelihoods of cerumen impaction. These disparities were attributed to physiological factors such as changes in ear canal shape and increased hair growth, as well as potential differences in cultural ear-cleaning practices.
Moreover, sociodemographic factors like race, education, and insurance status were linked to cerumen impaction, reflecting broader disparities in healthcare access and utilization. Efforts to improve health equity and access to care for cerumen impaction should focus on education and awareness among at-risk populations.
Interestingly, no significant association was found between hearing aid use and cerumen impaction, suggesting the need for further investigation into the impact of hearing devices on cerumen management.
The study also highlighted the clinical significance of cerumen impaction on hearing thresholds, emphasizing the need for prompt intervention to mitigate potential hearing loss. However, partial impaction did not significantly affect hearing thresholds, aligning with previous research.
Limitations of the study, such as its cross-sectional design and reliance on otoscopy by non-clinicians, were acknowledged. Recommendations for future research included examining temporal relationships and incorporating detailed examinations of cerumen characteristics.
In conclusion, cerumen impaction poses a significant public health concern in the United States, particularly among older adults and individuals from marginalized communities. Addressing sociodemographic disparities and improving access to care and education are crucial steps in mitigating the impact of cerumen impaction on hearing health and overall well-being. Efforts to disseminate guidelines and promote best practices for cerumen management are essential for enhancing health equity and improving outcomes for affected individuals.
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