IHS Cerumen Management

Question 1

Which of the following is an absolute contraindication for cerumen removal via irrigation in a hearing instrument specialist's scope of practice?

Accepted Answer

A perforated tympanic membrane

Answer

A perforated tympanic membrane is an absolute contraindication for ear irrigation because water entering the middle ear through the perforation can cause infection (otitis media) or further damage. Irrigation should never be performed when a perforation is suspected or confirmed.

Question 2

Before performing cerumen removal, a hearing instrument specialist should FIRST:

Accepted Answer

Perform an otoscopic inspection of the ear canal

Answer

Otoscopic inspection must always precede cerumen removal to assess the type and location of the cerumen, confirm the integrity of the tympanic membrane, and rule out contraindications such as perforation, foreign bodies, or active infection.

Question 3

Which type of cerumen is considered most difficult to remove and most likely to require referral to a physician?

Accepted Answer

Hard, impacted cerumen occluding the canal

Answer

Hard, impacted cerumen that completely occludes the ear canal poses the greatest risk of injury during removal and may require softening agents, specialized tools, or physician referral. It can also cause or mimic conductive hearing loss.

Question 4

A patient presents with a completely occluded ear canal due to cerumen, but reports a history of ear surgery with a mastoid bowl. The most appropriate action is to:

Accepted Answer

Refer the patient to a physician

Answer

A history of ear surgery creating a mastoid bowl significantly increases the risk of complications during cerumen removal. This is a contraindication for in-office removal by a hearing instrument specialist, and the patient should be referred to a physician or otolaryngologist.

Question 5

Which of the following ceruminolytic (wax-softening) agents is generally considered safe for home use prior to cerumen removal?

Accepted Answer

Hydrogen peroxide 3% solution

Answer

A 3% hydrogen peroxide solution (or carbamide peroxide drops) is a commonly recommended and FDA-approved ceruminolytic for home use. It softens wax through effervescence. Isopropyl alcohol is drying and potentially irritating; vinegar solutions are not standard ceruminolytic agents.

IHS - International Hearing Society Practice Test

IHS - International Hearing Society Practice Test

IHS Cerumen Management