Unpacking cerumen impaction: a systematic review of clinical practice guidelines to support the development of the world health organization package of ear and hearing care interventions.

BACKGROUND: Cerumen impaction is a common, preventable cause of hearing loss that affects up to 30% of the global population. Despite its high burden, management practices vary widely, highlighting the need for comprehensive, evidence-based guidelines. This systematic review was conducted to inform the World Health Organization’s (WHO) Package for Ear and Hearing Care Interventions (PEHCI) by identifying and appraising high-quality clinical practice guidelines for cerumen impaction. METHODS: A comprehensive search of bibliographic databases, guideline repositories, and organizational websites was conducted in August 2024. Guidelines published from 2014 onward were screened using predefined criteria. Eligible guidelines were assessed for quality using the AGREE II tool. Data were extracted using a standardized form based on the RIGHT checklist. RESULTS: Out of 74 initially identified articles, two met all inclusion criteria and demonstrated sufficient quality: one developed by the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS; total AGREE II score = 56.5) and the other by the UK’s National Institute for Health and Care Excellence (NICE; total AGREE II score = 62.5). Both guidelines emphasized patient education, symptom- and examination-based diagnosis, and use of cerumenolytics, irrigation, and manual removal for treatment. NICE discouraged manual syringes due to safety concerns, while AAO-HNS considered them a safe and acceptable treatment option when performed appropriately. CONCLUSION: This review highlights consistent, high-quality recommendations for cerumen impaction management and identifies areas of divergence relevant to global implementation. Findings will guide inclusion of cerumen impaction interventions in the WHO PEHCI and support the development of standardized, context-adaptable ear and hearing care services.