Introduction
The human ear is an essential organ of the human body that provides the hearing ability. It has various parts, such as the external ear, middle ear, and inner ear. The eardrum or tympanic membrane comprises thin tissues and a particular skin type; it is responsible for receiving sound waves or vibrations from the outside and transferring them to the inner ear.
The skin of the eardrum becomes dead and sheds off into the outer ear naturally. Along with this dead skin, the eardrum has two significant glands that secrete waxy oil. This mixture of dead skin and oily secretions is called earwax or cerumen and gets removed from the ear as a self-cleaning process. When this process is disturbed, the earwax fails to come outside and remains inside, resulting in impaction. The impacted cerumen causes various symptoms, among which hearing loss is the most common.
What Is Cerumen?
Cerumen, also known as earwax, is a wax developed or secreted by the auditory canal glands. The formation of cerumen is a normal process in human beings. The wax is brownish or yellowish.
What Is the Function of Cerumen?
The main functions of cerumen are to:
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Protect against infections caused by bacteria and fungus.
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Prevent water entry into the ear.
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Trap the dirt and foreign bodies.
What Are the Types of Cerumen?
It is of two types based on the composition:
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Wet Wax: It is sticky and wet, commonly seen in children,Caucasian, and African Americans.
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Dry Wax: It is dry and widely seen in Asians.
How Is Cerumen Removed From the Ear Naturally?
It is a self-cleaning process where the ear pushes or forces the cerumen out. The self-cleaning function occurs through the movements of the jaws.
What Is Cerumen Impaction?
When the removal of cerumen is disturbed or interrupted, then the cerumen becomes impacted within the ear because the ear fails to push or force the cerumen out of the ear.
What Is the Pathophysiology of Cerumen Impaction?
The human ear comprises three parts: the outer ear (external ear), the tympanic membrane (eardrum), and the inner ear. The primary function of the eardrum is to receive sound vibrations or waves from the outside and transfer it to the inner ear. When the eardrum receives waves, it vibrates. The tympanic membrane of thin tissues and a particular type of skin becomes dead and naturally sheds off into the outer ear. Along with this dead skin, the eardrum has two significant glands that secrete waxy oil. This mixture of dead skin and oily secretions is called earwax and is removed from the ear as a self-cleaning process. However, when the cerumen or earwax cleaning process is disturbed, the earwax fails to come outside of the ear canal and remains inside, resulting in impaction.
What Are the Symptoms of Cerumen Impaction?
Generally, the cerumen impaction is asymptomatic. However, sometimes, it may cause the following symptoms:
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Pain in the ear.
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Itching in the ear.
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Loss of hearing is the most common symptom.
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Ringing noise in the ear. It is called tinnitus.
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If there is a bacterial infection, then drainage may be seen.
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Vertigo or dizziness.
How to Diagnose Impacted Cerumen?
Generally, a simple clinical examination of the patient is enough to plan out the treatment. It includes the following:
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Physical Examination: The doctor can directly visualize the cerumen through an otoscope. It is an instrument with a light used to examine the ear canal and eardrum.
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Imaging Test: A computed tomography may show dense-soft tissues in the canal. Other anatomical structures of the ear will appear normal. Imaging tests are usually not performed until there is any cancerous condition present.
How Is Cerumen Impaction Removal Done?
If the patient is asymptomatic, then there is no recommended treatment. But if there is pain or other symptoms because of the cerumen, the doctor must remove it. There is no single technique or method to remove the impacted cerumen. Commonly used methods are mentioned below:
1. Cerumenolytic Agents: These are liquid-based solutions used to dissolve earwax. These are administered as ear drops for five to seven days. Carbamide peroxide is a commonly prescribed liquid.
2. Irrigation: It is a more safe and more effective method. Commonly, warm water combined with hydrogen peroxide is used to irrigate the ear canal. In this method:
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A syringe filled with 5 ml water alone or with hydrogen peroxide is fit with a tube catheter.
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The solution is injected into the ear canal.
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The solution is injected with a pressure that creates a jet lavage (mechanical hydrotherapy).
- It is done several times until the cerumen is removed completely.
3. Manual Technique: If irrigation is not possible or contraindicated, the manual technique is helpful for removing the cerumen.
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It is done with a unique instrument for better visualization, such as a binocular microscope.
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A metal or plastic curette or spoon used to remove the cerumen is inserted into the ear canal.
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Minor bleeding and discomfort may be seen before the curette.
What Are the Complications of Cerumen Impaction Removal?
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Perforation of eardrum after using cotton swabs.
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Trauma or injury to the ear canal.
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Secondary otitis (the inflammation or infection of the ear canal after the treatment, such as irrigation).
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Increased risk of impaction in the future.
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Hearing loss.
What Are the Contraindications of Cerumenolytic Agents?
These agents should not be used in the following:
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Patients who have an infection in their ear.
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Patients who have tympanostomy tubes. These are small plastic tubes surgically inserted into the ear canal of the patient to keep the flow of air into the middle ear.
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Patients who have perforated eardrums.
What Should Not Be Done During Cerumen Impaction Removal?
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Do not perform irrigation in a suspected case of eardrum perforation.
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Do not overuse cerumenolytic agents because their effectiveness is still unclear.
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Do not perform irrigation with cold or boiling water.
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Do not place or insert an instrument blindly or with a blunt force into the ear.
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Do not allow water to accumulate in the ear after irrigation. It may lead to secondary infection.
Conclusion
Cerumen impaction removal is the most common surgical procedure for the ear, nose, and throat (ENT). Cerumen or ear wax forms from the dead skin and gland secretions into the ear canal, which gets removed from the ear canal through a natural process. However, sometimes, the human ear fails to complete this process or gets interrupted, resulting in the impaction of the cerumen. Removing the impacted cerumen by the doctor is then recommended. The use of cerumenolytic agents, irrigation, and manual removal are three methods available for cerumen impaction removal.
