1. A. The licensee shall be responsible for obtaining the training, knowledge, and skills necessary to perform cerumen management.
2. B. Failure to obtain the training before performing cerumen management may subject the licensee to disciplinary action.

3. C. The licensee shall obtain training that includes:

   1. (1) Principles of cerumen management including the anatomy of the ear canal and the ear drum and classification of cerumen;
   2. (2) Use of instruments;
   3. (3) Techniques for cerumen removal;
   4. (4) Recognition of complications;

   5. (5) Recognition of contraindications including but not limited to:

      1. (a) Only hearing ear;
      2. (b) Perforated tympanic membrane;
      3. (c) Inflammation, tenderness, or drainage from the ear canal or middle ear;
      4. (d) Ear surgery within the past 6 months or tympanostomy tubes;
      5. (e) Diabetes mellitus, HIV infection, bleeding disorder, or other medical contraindications;
      6. (f) Actual or suspected foreign body;
      7. (g) Stenosis or bony exostosis of the ear canal;
      8. (h) Dizziness occurring during cerumen removal;
      9. (i) Cerumen impaction that totally occludes the ear canal; and
   6. (6) Clinical experience gained under the direct supervision of a qualified professional.
4. D. The licensee shall maintain documentation evidencing the satisfactory completion of the required training.

Authority: Health Occupations Article, §§2-101(n) and 2-205(a)(1), Annotated Code of Maryland

Effective date: December 18, 1995 (22:25 Md. R. 1962)

Regulation .05B amended effective January 6, 2005 (31:26 Md. R. 1863)