title: Cerumen: A fundamental but neglected problem by pediatricians.
abstract: OBJECTIVE
  Under physiological conditions, cerumen (Ce) is regularly extruded from the ear canal by a self-cleaning mechanism. Failure of this mechanism leads to excessive accumulation or impaction of Ce. Limited data are available concerning the prevalence of cerumen in healthy and sick infants and children. We assessed the prevalence of Ce in a large population of infants and children and compared the Ce removal attitudes of paediatricians (PEDs) and otorhinolaryngologists (ENTs).
  
  
  METHODS
  Children seen in November 2014 for acute respiratory infections, including suspected acute otitis media, or well-being visits, were enrolled. The following data were recorded: presence, laterality, and amount of Ce; presenting complaints and final diagnosis; attempt to remove Ce during the visit; and type of physician.
  
  
  RESULTS
  Among 819 children aged 1 month to 12 years, Ce was present in 594 (72.5%), of whom 478 (80.5%) had bilateral Ce, and 261 (43.9%) had Ce in a relevant amount (cerumen obstructing at least 50% of the ear canal). Presence of Ce was more common in younger and in African or Asian children. PEDs were less likely to remove cerumen than ENTs (28.8% vs 91.0%, p < 0.001) irrespective of age, gender, race and reason for visit. Ce was removed by PEDs in less than one-third of sick children with a final diagnosis of acute otitis media (AOM) (31.6%) compared with almost all the children by ENTs (95.6%, p < 0.001).
  
  
  CONCLUSIONS
  Ce is highly prevalent in healthy and sick children but is quite neglected by PEDs. Educational programs to reinforce the importance of Ce removal and to improve the techniques for removal in case of suspected AOM should be implemented and rigorously evaluated in order to avoid incorrect diagnosis and erroneous treatments.
authors.affiliation: Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: paola.marchisio@unimi.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Marchisio
authors.affiliation: Otolaryngology-Head and Neck Unit, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Pipolo
authors.affiliation: Primary Care Pediatrician, Turin, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Landi
authors.affiliation: Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.affiliation: Department of Otolaryngology, Ospedale Santobono Pausilipon, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mansi
authors.affiliation: Primary Care Pediatrician, Caserta, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Mauro
authors.affiliation: Department of Pediatrics, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Salvatici
authors.affiliation: Pediatric Emergency Department, IRCCS Ospedale Gaslini, Genoa, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Di Pietro
authors.affiliation: Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.affiliation: Otolaryngology-Head and Neck Unit, Department of Health Sciences, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Felisati
authors.affiliation: Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
mesh_terms: D000208:Acute Disease; D001291:Attitude of Health Personnel; D002571:Cerumen; D002648:Child; D002675:Child, Preschool; D004424:Ear Canal; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010033:Otitis Media / Q000175:diagnosis; D010036:Otolaryngology; D010372:Pediatrics; D010818:Practice Patterns, Physicians'
keywords: Cerumen; Otitis media; Otoscopy