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 panicles, 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.

*      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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