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Introduction
Cerumen is the naturally occurring and normally secreted product of the external auditory canal (outer ear canal). Cerumen (wax) protects the skin in the ear canal. Ear Canal does not cause problems in most of the people but in some people Cerumen gets built up and blocks the canal. This is Cerumen impaction or wax blockage.
Alternative Names:
- Wax blockage
- Ear impaction
- Ear blockage
- Ear wax
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Causes & Risk factors
Cerumen impaction is usually caused by failure of the ear to clear itself naturally.
Factors that contribute to the impaction of the ear wax are:
- Attempts to remove the ear wax by insertion of cotton swabs
- Insertion of other objects into the ear to remove the wax which in fact pushes the ear wax deeper inside.
Risk Factors:
- A twisted, complicated and narrow ear canal.
- Cerumen overproducing ears.
- Age: Impaction is more in elderly than in the young.
- Habit of putting objects in the ear to clean the wax.
- Intellectual disability
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Diagnosis
History of the complaints narrated by the patient combined with the physical examination can establish the diagnosis. The ear wax can be visualized directly by a instrument called as Otoscope. | |
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The ‘Dont’ in Cerumen Impaction
Do not attempt to remove the ear wax by yourself. By doing so, there are high chances of:
- Damage to the tympanic membrane (ear drum)
- Injuries to the ear canal
- Ear wax becoming more impacted and getting pushed deeper inside
- Swimmer’s ear: It is basically infection of the skin that lines the ear canal
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Differential Diagnosis
- Foreign body
- Swollen ear canal
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Complications
Hearing loss, otitis externa, dizziness | |
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Symptoms
- Itching in the ears
- Pain in the ears
- Tinnitus (constant ringing in the ears)
- Loss of hearing
- Fullness in the ears
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Treatment
Removal of the ear
Manual removal by using
- Curette: It is a surgical instrument which is shaped like a scoop.
- Suction: The loose wax is removed by using vacuum.
Ceruminolytic agents: A liquid like solution that is to be put in the ear which softens the ear wax and thus helps to remove it. There are usually 3 types. Water based, oil based, non oil based non water based.
Some water based ceruminolytics are Docusate sodium, 3% Hydrogen peroxide.
Some oil based ceruminolytics are Olive oil, Almond Oil.
Some non oil non water based ceruminolytics are carbamide peroxide.
Flushing Method: This method can be used with or without the pretreatment with Ceruminolytics.
Gentle traction is given to the external ear in upward and backward direction. This makes the ear straighten up. The impacted Cerumen is then flushed using flushing instrument.
The patients of middle ear diseases, ear surgeries, otitis externa and vertigo are best to avoid the ear impaction. | |
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Prognosis
Cerumen impaction has excellent prognosis with removal attempts. However it has a tendency of reoccurrence. Hearing loss, if any, is transient and it returns totally once the ear wax is removed. | |
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