Cerumen removal. How necessary is it to diagnose acute otitis media?

We evaluated the consistency and appearance of aural cerumen and the degree to which such cerumen obscured the view of the eardrum in 279 children with unilateral acute otitis media with effusion (AOME). Mechanical removal of cerumen was necessary overall in 29% of the patients. Cerumen removal was inversely proportional to age, and we found it necessary to remove such cerumen to visualize most of the eardrum in 35 (57%) of 61 infants with AOME. Some physicians believe that the heat generated from an intensely inflamed middle ear will invariably cause sticky, honey-colored cerumen to liquefy. Only 29 children (11%) in this study had aural cerumen with a soft cheesy or semiliquefied consistency.