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April 6, 1984

Removal of Cerumen-Reply

Author Affiliations

Chief Editor Archives of Otolaryngology

JAMA. 1984;251(13):1681. doi:10.1001/jama.1984.03340370021012

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In Reply.—  Regarding the use of high-pressure water irrigation to remove cerumen from the external auditory canal, I am willing to acknowledge both the importance of saving time and the comparative safety of irrigation when the patient has an intact, strong, and healthy tympanic membrane. I also agree that irrigation is a physician error in the presence of tympanotomy tubes but would point out that the error is more likely to occur when irrigation is used routinely than when foreign matter is removed with a cerumen loop or suction. Foreign material, of course, may prevent the examiner from visualizing the presence of the tube.My objection to routine, high-pressure irrigation is based on observation of iatrogenic otitis media in three categories of patients: (1) patients with a tympanotomy tube that is not seen because of foreign material in the external canal, (2) patients with an unsuspected tympanic membrane perforation, and