Cerumen impaction: Prevalence and associated factors in the United States population.

Objective: To examine the prevalence of cerumen impaction in a nationally representative sample of the US population and the association of cerumen impaction with sociodemographic factors, hearing loss, and tinnitus. Methods: The cohort included 14,230 individuals aged ≥12 years who completed otoscopy and audiometry in NHANES (2005-2016). Cerumen impaction (partial/complete) was determined by otoscopy. Hearing level was defined by speech-frequency pure-tone average (PTA). Multivariable regression analysis was performed to identify factors associated with cerumen impaction. Results: The prevalence of any cerumen impaction was 18.6% [95% CI: 17.3%-19.9%] among individuals ≥12 years and 32.4% [29.9%-35.1%] among those ≥70 years. The prevalence of bilateral partial and complete cerumen impaction was 6.3% [5.6%-7.1%] and 1.2% [1.0%-1.9%], respectively. Any cerumen impaction was associated with male sex (OR 1.77 [1.5-2.1]), identifying as Black race (vs. Caucasian, OR: 1.78 [1.5-2.9]), lower level of education (OR: 0.84 [0.71-0.98]), and older age (OR: 1.02 [1.01-1.03]). After adjusting for sociodemographic and clinical factors, complete impaction was associated with increased PTA (right ear: ß = 4.1 dB [2.4-5.8 dB], left ear: ß = 1.9 dB [0.46-3.4 dB]), but not with tinnitus. Conclusions: Cerumen impaction is highly prevalent in the US population, especially among older adults, and has disproportionate sociodemographic impacts. Complete impaction is associated with a small, statistically significant elevation in PTA, but there is no association with tinnitus. These findings emphasize the need to implement and disseminate best practices for ear hygiene and cerumen management broadly and equitably. Level of Evidence: 2B.

Primary Repair of Ear Avulsion with Adjuvant Hyperbaric Therapy and Nitroglycerin Ointment.

Traumatic auricular avulsion is a rare and deforming injury. Classically, repair has required microvascular anastomosis. In this publication, we report two separate cases of pediatric auricular avulsion from dog bites. In both cases, the ear was cleaned and surgically reattached. Adjunctive therapies included hyperbaric oxygen and nitroglycerin ointment. There was complete graft take for one patient and 90% graft take for the second, both achieving satisfactory aesthetic outcome. These unique cases highlight the benefits of surgical reattachment of the avulsed portion of the ear followed by hyperbaric oxygen therapy and nitroglycerin ointment.