Association between oral feeding versus enteral feeding and cerumen impaction in older hospitalized adults: A retrospective cohort study

Background: Chewing involves jaw movements that propel cerumen along the ear canal. This mechanism may be reduced in dysphagia, especially for older individuals who are enterally fed. Those patients may be at a higher risk for cerumen impaction and may require longer hospital stays. Examining the relationship between diet type, cerumen impaction, and hospital stay duration was the focus of the present study. Methods: We performed a retrospective cohort study (not registered) among 114 hospitalized older adults. Data were collected on diet type: (1) oral feeding (individuals fed a solid diet or a pureed diet) or (2) enteral feeding (individuals fed via a feeding tube). The results of an otoscopy that quantified cerumen were recorded, as well as hospital stay duration. Results: In a mediation analysis, a hospital stay of >1 month was associated with an increased risk of enteral feeding, which in turn, increased the risk of cerumen impaction. Analysis indicated that the link between longer hospitalization and a more severe level of cerumen impaction was fully mediated by diet type (enteral feeding). Conclusions: Enteral feeding seems to be a risk factor for cerumen impaction, rather than merely hospitalization length, in our sample of geriatric patients. These results highlight the importance of continuous monitoring by ear, nose, and throat specialists, as well as regular auditory assessments for patients who are enterally fed for early detection and treatment of cerumen impaction. Particular attention should be paid to cases of prolonged hospitalization, which is associated with the severity of dysphagia.