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Impacted cerumen image - Coggle Diagram
Impacted cerumen 
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Pathophysiology
This hearing impairment is painless. Impacted earwax is often found in infants, because the large cotton swabs used to remove the wax often push it further into the baby’s tiny ear canal
Normally the wax produced by skin glands in the outer ear migrates outward. If the earwax is produced too rapidly, it may become hardened and accumulate, thus plugging the outer ear canal and preventing sound passage to the tympanic (eardrum) membrane.
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Causes
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The most common cause of impactions is the use of cotton swabs (and other objects such as bobby pins and rolled napkin corners), which can remove superficial wax but also pushes the rest of the wax deeper into the ear canal.
Nursing interventions
Have the client sit up or lie with the head tilted toward the side of the affected ear. Have the client support a basin under the ear to receive the irrigating solution.
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Clean the pinna and the meatus at the auditory canal as necessary with the normal saline or the irrigating solution.
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When the irrigation is completed, place a cotton ball loosely in the auditory meatus and have the client lie on the side of the affected ear on a towel or an absorbent pad.
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References
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AskMayoExpert. Cerumen impaction. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
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