Cerumen

 

EN4.2

 

Domain: K/S

 

Level: SH

 

Core: Y

 

Suggested learning method: Lecture, Small group discussion, DOAP session, Bedside clinic

 

Suggested assessment method: Written/ Viva voce/ Skill assessment

 

 

Impacted cerumen:

 

Introduction:

 

Impaction of cerumen is defined as accumulation of cerumen that causes symptoms, prevents assessment of the ear of both.  Cerumen impaction in external canal is physiological.

Cerumen is also known as ear wax and is a hydrophobic protective covering of the skin lining of the external auditory canal.  It shields the skin lining of external canal from water damage, infection, trauma and foreign bodies.

 

This is a yellowish waxy substance secreted in the external auditory canal of humans. It protects the skin lining of the external auditory canal from excessive moisture. It also protects the external canal from bacteria, fungi and insects.

 

Humans are known to secrete two types of cerumen:

Soft and moist

Firm and dry

Persons secreting soft and moist type of ear wax have no problem due to its accumulation. It can easily be extruded by the normal cleansing mechanism of the external auditory canal. This difference in wax secretion has been traced to alterations in C11 gene. Persons secreting frim and dry wax are more prone for impaction of cerumen. Impaction of cerumen causes conductive hearing loss.

Cerumen is usually produced in the outer third of the cartilagineous portion of the external auditory canal. It is composed of:

Viscous secretions from sebaceous glands

Less viscous secretions from modified apocrine sweat glands

Shed layers of skin

Cerumen has been found to have bacterostatic effect. Excessive occlusion of the external canal due to accumulation of cerumen and desquamated epithelial cells associated with migration defect of the lining epithelium can cause keratosis obturans. This is a painful condition which needs to be treated by removing the mass under anesthesia.

Removal of cerumen can be performed using probes / curettes if the consistency is soft. If cerumen is excessively soft then cotton buds can be used for removal.

The patient should be advised to avoid the use of cotton tip applicator for routine cleaning.  Normal external canal skin desquamates in such a way that wax tends to be pushed outside.  Attmepting to clean the external auditory canal using cotton applicators will push the wax deeper into the canal.

 

Indications for removal of cerumen:

 

1. Difficulty in examining the ear drum

2. Otitis externa

3. Wax occlusion of the external canal

4. As a part of workup for conductive hearing loss

5. Prior to taking the impression for hearing aid fitting

6. As part of follow up of canal down mastoidectomy

7. As a part of grommet insertion or middle ear surgery

8. Itchy ears

9. Reflex cough

10. Patient request

11. FB removal

 

 

Cerumen removal:

 

Firm cerumen should be lubricated by using ceruminolytics / liquid paraffin to soften it up before attempted removal.

Aural syringing is one of the painless way of removing accumulated cerumen.