Ear wax/cerumen impaction

Notes

## Basic introduction

  • Ear wax (cerumen) provides protection of the skin of the ear canal, assists in cleaning and lubrication as well as providing protection against bacteria, fungi and insects.
  • Earwax is a mixture of secretions from sebaceous glands and modified apocrine sweat glands whose key constituents are shed layers of skin, saturated and unsaturated long-chain fatty acids, alcohols, squalene, and cholesterol.
  • Some people produce excessive earwax that prevents the passage of sound in the ear canal leading to conductive loss of hearing.
  • The natural cleaning process of the ear is assisted by the movement of the jaw.

## Statistics

  • The global prevalence of cases of impacted cerumen is 3- 6% in healthy adults, up to 10% in children and 22 -36% in adults with mental retardation and in older adults.
Symptoms
  • Physical presence of cerumen on examination of the ear
  • Hearing loss
Diagnosis
  • Clinical review that include physical examination of the ear using otoscope, a handheld speculum, or a binocular microscope.
Differential
  • Foreign body in ear canal
  • Polyp of ear canal
  • Osteoma of ear canal
  • Keratosis obturans
  • External otitis media
Prevention
  • Routine medical check-up and preventive cleaning of the ear.
Reference

a. Ernst AA, Takakuwa KM, Letner C, Weiss SJ (September 1999). "Warmed versus room temperature saline solution for ear irrigation: a randomized clinical trial". Annals of Emergency Medicine. 34 (3): 347–50.

b. Sharp JF, Wilson JA, Ross L, Barr-Hamilton RM (December 1990). "Ear wax removal: a survey of current practice". BMJ. 301 (6763): 1251–3.

c. Roland PS, Eaton DA, Gross RD, et al. Randomized, placebo-controlled evaluation of Cerumenex and murine earwax removal products. Arch Otolaryngol Head Neck Surg. 2004;130:1175-1177.

Management
  • The removal of the earwax is discouraged unless it is excessive and it is causing hearing challenges.
  • Complications that may arise from the improper methods of earwax removal include pain, perforated tympanum, dizziness, bleeding, and infection
  • The use of cotton swabs to remove the earwax is discouraged as they are known to push the wax farther down the ear canal and even cause the perforation of tympanum
  • Wax softeners or cerumenolytics can be useful in the removal of earwax and they include the following:

_A solution of sodium bicarbonate in water

_Docusate

_Peanut oil, turpentine and dichlorobenzene

_Triethanolamine, polypeptides, and oleate-condensate

_Urea hydrogen peroxide and glycerine

  • Syringing the ear with warm water at 37 degree centigrade (or normal saline or sodium bicarbonate solution or a solution of water and vinegar) is the most preferred method of removing the earwax.
  • Prior application of cerumenolytics before syringing is often advised.
  • Ear picking/curetting that physically dislodges the earwax and scoops it out of the ear canal. It is performed by the trained healthcare personnel, especially in subjects with dry type of earwax.
  • Cotton swab should be used strictly to clean the external ear. Otherwise, it can cause push the wax farther down the ear canal and even cause perforation of tympanum
  • The ear must be re-examined carefully after the removal of cerumen to ensure that the removal is complete and that the tympanic membrane is intact.
Drug Index 2.0 is here
Our new update features a more powerful search feature and easier login. Having any issues? Contact us today. Contact Us