Impacted wax / cerumen
Wax is a mixture of secretion of
sebaceous and ceruminious glands, hairs, desquamated epithelial debris and dirt
in the external auditory canal.
It is brownish or yellowish in color
due to oxidative causes
Function of wax:
* repel
water
* trap
dust, sand particles, micro-organisms, and other debris
* moisturize
epithelium in ear canal
* odor
discourages insects
* antibiotic, antiviral, antifungal properties
Ceruminous glands secrete watery
fluid whereas sebaceous gland has a fatty secretion. It may become black or
greyish when mixed with desquamated keratinized epithelium.
Excretion of wax from the external
auditory canal is helped by movement of the jaw while eating and talking.
Causes of excessive wax collection:
* over
activity of ceruminous glands and excess secretion of wax
* excessive
desquamation of the canal wall
* less
oily sebaceous secretion
* narrowed ear canal
* excessive obliquity of the canal
* obstructive lesions of ear canal
* presence of stiff hair
* presence
of exostosis
* occupational factors- seen among miners
* living
in hot and dry climate
*
more in apprehensive patients
Clinical manifestation:
*otalgia- when there is associated otitis
externa
*tinnitus and vertigo
*irritation and itching
*cough reflex- initiated through tympanic
branch of vagus
*hearing loss/ deafness- present when
the canal is completely occluded.
Management:
* syringing for soft wax
* waxolytic agents for impacted wax to
soften the wax. It can then be removed by syringing/ suctioning
* use a hook or forceps- hooking for firm
wax. Before hooking, a small tunnel has to be made in the posterosuperior part
between the canal and the wax
Instrumental manipulation:
* it
should be done by skilled hands under direct vision.
* scoop
or jobson horne probe used often
* wax is soften by 5% soda bicarb + equal
parts of glycerine + water (dewax)
*hydrgoen peroxide, liquid paraffin
or olive oil
Educational points
* wax
is a normal physiological substance which has an important role in protecting
the ear canal.
* the
ear canal is a self-cleaning system, do not to use cotton buds as wax is more
likely to be pushed back against the eardrum and become impacted
* ear
wax only needs to be removed if it causes symptoms or if a proper view of the
eardrum is needed.
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