1. (1) An individual certified to perform cerumen management shall refer a patient to an otolaryngologist or licensed physician for cerumen management when the patient presents with any of the following:

   1. (a) They are less than 18 years of age.
   2. (b) A perforated tympanic membrane.
   3. (c) History of pain, active drainage, or bleeding from the ear.
   4. (d) Evidence of congenital or traumatic deformity of the ear.
   5. (e) On anticoagulant therapy.
   6. (f) Are immunocompromised.
   7. (g) Have diabetes mellitus.
   8. (h) History of prior radiation therapy to the head and neck.
   9. (i) History of ear canal stenosis or exostoses.
   10. (j) A nonintact tympanic membrane.
   11. (k) Had ear surgery within the last six months.
   12. (L) Tympanostomy tubes.
   13. (m) A bleeding disorder.
   14. (n) An actual or suspected foreign body in the ear.
   15. (o) Stenosis or bony exostosis of the ear canal.
   16. (p) Cerumen impaction that totally occludes the ear canal.
   17. (q) Cerumen located medial to the cartilaginous external auditory canal or beyond the second bend.
   18. (r) A tympanic membrane that the certified individual is unable to see.
   19. (s) Vertigo.

2. (2) The certified individual shall immediately stop the procedure and refer a patient to an otolaryngologist or a licensed physician if any of the following occur while performing cerumen management:

   1. (a) Significant pain.
   2. (b) Uncontrolled bleeding.
   3. (c) Laceration of the external auditory canal or beyond the second bend.
   4. (d) Acute onset of dizziness or vertigo.
   5. (e) Sudden hearing loss.

History

History: CR 25-044: cr. Register April 2026 No. 844, eff. 5-1-26.