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.
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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