Cerumen impaction

Cerumen impaction

Fig.3.11.

Definition

Cerumen impaction is a condition in which earwax has become tightly packed in the external ear canal to the point that the canal is blocked.

(Fig 3.11.)
Ear wax is removed by flushing the ear canal with warm fluid.

Description

Cerumen impaction develops when earwax accumulates in the inner part of the ear canal and blocks the eardrum. It affects between 2% and 6% of the general population in the United States.



Impaction does not happen under normal circumstances because cerumen is produced by glands in the outer part of the ear canal; it is not produced in the inner part. The cerumen traps sand or dust particles before they reach the ear drum. It also protects the outer part of the ear canal because it repels water. The slow movement of the outer layer of skin of the ear canal carries cerumen toward the outer opening of the ear. As the older cerumen reaches the opening of the ear, it dries out and falls away.

Diagnosis

The diagnosis of impacted cerumen is usually made by examining the ear canal and eardrum with an otoscope, an instrument with a light attached that allows the doctor to look into the canal.



Causes and symptoms

Cerumen is most likely to become impacted when it is pushed against the eardrum by cotton-tipped applicators, hair pins, or other objects that people put in their ears; and when it is trapped against the eardrum by a hearing aid. Less common causes of cerumen impaction include overproduction of earwax by the glands in the ear canal, or an abnormally shaped ear canal.

The most important symptom of cerumen impaction is partial loss of hearing. Other symptoms are itching, tinnitus (noise or ringing in the ears), a sensation of fullness in the ear, and pain.

Treatment

Irrigation is the most common method of removing impacted cerumen. It involves washing out the ear canal with water from a commercial irrigator or a syringe with a catheter attached. Although some doctors use Water Piks to remove cerumen, most do not recommend them because the stream of water is too forceful and may damage the eardrum. The doctor may add a small amount of alcohol, hydrogen peroxide, or other antiseptic. The water must be close to body temperature; if it is too cold or too warm, the patient may feel dizzy or nauseated. After the ear has been irrigated, the doctor will apply antibiotic ear drops to protect the ear from infection.

Irrigation should not be used to remove cerumen if the patient's eardrum is ruptured or missing; if the patient has a history of chronic otitis media (inflammation of the middle ear) or a myringotomy (cutting the eardrum to allow fluid to escape from the middle ear); or if the patient has hearing in only one ear.

If irrigation cannot be used or fails to remove the cerumen, the patient is referred to an ear, nose, and throat (ENT) specialist. The specialist can remove the wax with a vacuumdevice or a curette, which is a small scoop-shaped surgical instrument.

Some doctors prescribe special ear drops, such as Cerumenex, to soften the wax. The most common side effect of Cerumenex is an allergic skin reaction. Over-the-counter wax removal products include Debrox or Murine Ear Drops. A 3% solution of hydrogen peroxide may also be used. These products are less likely to irritate the skin of the ear.

Alternative treatment

One alternative method that is sometimes touted as a way to remove impacted cerumen is ear candling. Ear candling involves the insertion of a burning candle or a cone of wax-soaked linen or cotton into the affected ear. The person lies on his or her side with the affected ear uppermost. A collecting plate is placed on the ear to catch melted wax. The cone or candle is threaded through a hole in the plate into the ear canal and lit. A variation on this technique involves blowing herbal smoke into the ear through homemade pottery cones. Practitioners of ear candling claim that the heat from the burning candle or smoke creates a vacuum that draws out the impacted cerumen. Some also claim that ear candling improves hearing, relieves sinus infections, cures earache or swimmer's ear, stops tinnitus, or purifies the mind. None of these claims are true. Ear candling is not recognized as an acceptable alternative practice by naturopaths, homeopaths, practitioners of Native American medicine, or any other authority on complementary and alternative medicine.

Ear candling is not only an ineffective way to remove impacted cerumen, it can actually damage the ear. According to a 1996 survey of 122 otolaryngologists (doctors who specialize in treating ear, nose, and throat disorders) in the Spokane area, the doctors reported 21 severe ear injuries resulting from ear candling, including 13 cases of external burns, 7 cases of ear canal obstruction from melted candle wax, and 1 case of eardrum perforation. Ear candles cannot legally be sold as health devices in the United States because they do not have Food and Drug Administration (FDA) approval. A similar ban is in effect in Canada. Ear candles are, however, available over the Internet and in some health food stores with the labeling "for entertainment only."

Prognosis

In most cases, impacted cerumen is successfully removed by irrigation with no lasting side effects. Irrigation can, however, lead to infection of the outer or the middle ear if the patient has a damaged or absent ear drum. Patients who try to remove earwax themselves with hair pins or similar objects run the risk of perforating the ear drum or damaging the fragile skin covering the ear canal, causing bleeding and the risk of infection.

Prevention

The best method of cleaning the external ear is to wipe the outer opening with a damp washcloth folded over the index finger, without going into the ear canal itself. Two techniques have been recommended to prevent cerumen from reaccumulating in the ear. The patient may place two or three drops of mineral oil into each ear once a week, allow it to remain for two or three minutes, and rinse it out with warm water; or place two drops of Domeboro otic solution in each ear once a week after showering.

Patients who wear hearing aids should have their ears examined periodically for signs of cerumen accumulation.