目的：施設高齢者における１２週間の耳垢除去の効果を明らかにするため、看護職が行う耳 垢除去による聴力の変化および耳垢の性状と蓄積経過との関係を明らかにする。 方法：対象は、外耳道に異常がなく、MMSE２１点以上および聴力検査が可能な１０名１９耳で ある（聴力検査不可１耳は除外した）。耳垢除去は、１２週間２週毎の外耳道の観察と、耳垢 によって外耳道が１/２以上閉鎖した場合に軟骨部外耳道の耳垢を除去した。聴力は、気 導・骨導聴力レベル（四分法）より気骨導差を算出した。耳垢蓄積は４段階、耳垢の性状 は湿型と乾型に分類した。 結果：耳垢除去介入開始時、耳垢により１/２閉鎖もしくは完全閉鎖の外耳道は７耳３６８. ％ であった。これらの７耳は、１２週間後において、'１/２閉鎖'と'１/３閉鎖'各１耳、 '閉鎖なし'が５耳となった。耳垢除去前後に聴力検査を行った１０耳のうち、「完全閉鎖→ 完全閉鎖」１耳を除外した９耳において、除去前に比べて除去後の閾値が有意に低下し聴 力改善が示された（気導聴力：前３５４. dB＞後３２８. dB P=００.４３、気骨導差：前５８. dB＞後２８. dB、 P=００.０２、t 検定）。湿型耳垢（８耳）は乾型耳垢（１１耳）より、１/２閉鎖および完全閉鎖 の耳垢蓄積の割合が有意に高かった（P=００.０１、Cram rのV検定）。耳垢の蓄積期間は、「閉 鎖なし→１/３閉鎖・１/２閉鎖」が約８週であり、性状の差はなかった。 考察：耳垢除去の効果として、聴力改善が示唆された。また、湿型耳垢は乾型耳垢より蓄 積しやすいことが示された。看護職が行う耳垢除去は、外耳道の観察が必要であり、これ が耳垢蓄積の予防につながると考える。 : To investigate the effects of cerumen removal among institutionalized elderly individuals, we evaluated changes in hearing with cerumen removal by nursing staff and the relationship between earwax type and accumulation. : This study included 10 subjects (19 ears) without abnormalities of the external auditory meatus (EAM), with a mini-mental state examination score ＞＿ 21, and in whom audiometry could be performed (One ear was excluded from the study because hearing test could not be performed). Over a 12-week period, the EAM was examined every 2 weeks. If the EAM was at least half occluded by cerumen, cerumen removal from the cartilaginous EAM was performed using a cotton swab. In terms of hearing, the air-bone gap was calculated from air conduction and bone conduction hearing levels. Criteria for cerumen accumulation, based on the degree of EAM occlusion by cerumen, were divided into 4 grades : completely occluded ; half occluded ; one-third occluded; and unoccluded. Earwax type was classified as wet-type earwax or dry-type earwax. : At baseline, before cerumen removal, the EAM was at least half occluded by cerumen in 7 ears (36.8%). After 12 weeks, of these 7 ears, 1 remained half occluded, 1 remained a third occluded and 5 were unoccluded. Hearing before and after cerumen removal was evaluated by audiometry in 10 ears. In 9 ears, excluding the 1 ear that remained completely occluded, the threshold after removal decreased significantly compared to before removal, with improved hearing (air conduction hearing, 35.4 dB before vs. 32.8 dB after, P=0.043 ; air-bone gap : 5.8 dB before vs. 2.8 dB after, P=0.002, paired -test). The rate of severe earwax accumulation (at least half occluded) was significantly higher with wet-type earwax (8 ears) than with drytype earwax (11 ears) (P=0.001, Cramer's test). Earwax accumulation time (from unoccluded to one－third or to－half occluded) was about 8 weeks. No difference between earwax types was identified. : Cerumen removal improved hearing. Wet-type earwax accumulated more easily than dry-type earwax. Cerumen removal by nursing staff requires examination of the EAM and thus provides preventive earwax accumulation.[原著]