Cerumen is a protective secretion produced by the outer portion of the ear canal In most persons, the ear canal is selfcleansing Recommended hygiene consists of cleaning the external opening only with a washcloth over the index finger Cerumen impaction is most often self-induced through illadvised cleansing attempts by entering the canal itself It may be relieved by the patient using detergent ear drops (eg, 3% hydrogen peroxide; 6 5% carbamide peroxide) and irrigation, or by the clinician using mechanical removal, suction, or irrigation Irrigation is performed with water at body temperature to avoid a vestibular caloric response The stream should be directed at the posterior ear canal wall adjacent to the cerumen plug Irrigation should be performed only when the tympanic membrane is known to be intact Use of jet irrigators (eg, WaterPik) should be avoided since they may result in tympanic membrane perforations Following irrigation, the ear canal should be thoroughly dried (eg, by the patient using a hair blow-dryer on lowpower setting or by the clinician instilling isopropyl alcohol) to reduce the likelihood of external otitis Specialty referral is indicated if impaction is frequently recurrent, if it has not responded to routine measures, or if there is tympanic membrane perforation or chronic otitis media