7 Common symptoms include conductive hearing loss, ear pain, itching or fullness, dizziness, tinnitus or reflex cough. Wax is usually described as impacted if it obscures visualisation of the tympanic membrane and is associated with symptoms. 6 Indications for treatmentĬerumen accumulation is normal and does not require treatment unless it is symptomatic. 5 Cerumen impaction is present in up to 57% of older patients, compared with 5% of younger, healthy adults. 4 Furthermore, the ceruminous glands atrophy with age and produce a drier wax that migrates more slowly. Cotton buds also tend to push cerumen deeper into the ear canal, and hearing aids and ear plugs obstruct the ear canal and contribute to cerumen accumulation over time.
DO ENT DOCTORS REMOVE EAR WAX SKIN
Irritation from foreign objects placed in the ear (eg cotton tips, hearing aids and ear plugs) can cause chronic changes to the skin of the ear canal and impair normal epithelial migration. Narrowing or obstruction of the ear canal, due to anatomical variations or infectious or dermatological diseases, can interfere with the normal migratory process.
When the self-cleaning mechanism is disrupted, wax accumulates and can become impacted. This is aided by epithelial migration and movement of the jaw. It is the ear’s self-cleaning mechanism, and traps dust and dirt, which are then excreted from the ear canal in a medial to lateral direction. It forms a protective film, has antibacterial properties and provides lubrication to the ear canal. In paediatric patients, the pinna should be pulled downwards and backwards.Įar wax is the product of ceruminous and sebaceous gland secretions, mixed with exfoliated squamous epithelium. To visualise the EAC and tympanic membrane in the adult, the pinna should be gently pulled upwards and backwards. The external auditory canal (EAC) curvature is different in adult and paediatric patients. The tympanic membrane faces downwards and laterally ( Figure 1B). Side effects of ear syringing, which will be discussed later in this article, involve many of these nerves. Innervation of the ear is from multiple nerves including the cervical plexus, trigeminal nerve (CNV), facial nerve (CNVII), glossopharyngeal (CNIX) and vagus nerves (CNX). The blood supply is from branches of the external carotid artery. The external ear consists of the pinna, ear lobe, conchal bowl and external acoustic meatus ( Figure 1A). The following is a brief review of the external ear and tympanic membrane anatomy. Ear anatomyĪ knowledge and understanding of normal ear anatomy is essential in the correct management of impacted cerumen with the use of ear syringing. This article will discuss the composition of ear wax, why it accumulates, treatment options and potential complications, to assist GPs in safely managing this condition. 1 As a consequence, one in five medico-legal cases involving GPs are related to ear syringing. However, 1 in 1000 patients experience major complications following syringing. 1 It is considered by most to be effective and safe.
Ear syringing is often the treatment of choice, and most GPs see a minimum of two patients per week for ear syringing. Cerumen impaction (also known as ear wax) is a common presentation to a general practitioner (GP).
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