Overview of Cerumen Impaction Removal
Cerumen, or earwax as we commonly know it, is produced by our bodies and several other animals. The earwax serves multiple purposes. It helps to keep the skin in our ear canal moist so that it doesn’t dry out, it creates a protective layer against water and any foreign objects that might want to get into our ear, and it even keeps out insects.
Normally, our jaw movements, such as when we eat or talk, naturally help to push the earwax out of our ear canal. This may not be the case for everyone, though. In certain people, this process may not work as it should, and the earwax might get stuck or build up in the ear. This is known as cerumen impaction.
Cerumen impaction is when the earwax blocks the ear canal completely or pushes against the eardrum. This might make someone feel like their ear is full or blocked, and it can lead to hearing loss, itching and even pain. It is one of the most common complaints related to the ear and is seen by healthcare providers in the United States. Up to 6% of the general population may have this issue, making it especially common among children (10%) and the elderly (more than 30%). This is also a common problem for people who use hearing aids or earplugs regularly or those who have a natural abnormality in their ear canal structure.
Cerumen impaction can often slip through the cracks and may not be diagnosed or treated as it should be. It is the cause behind 12 million patient visits and results in 8 million removal procedures every year in the United States alone. It can mess with the doctor’s ability to examine your eardrum, hearing tests and the fitting of hearing aids. A healthcare provider usually spots it by looking in your ear with a tool called an otoscope, but in some cases, they might need more advanced equipment like an operating microscope to remove the built-up earwax.
Anatomy and Physiology of Cerumen Impaction Removal
Earwax, or cerumen, is mainly made up of dead skin cells, which make up about 60% of its total substance. The rest is a mix of fats and proteins produced by the sweat and oil glands in the outer part of the ear canal. The exact makeup can vary, with harder earwax containing more skin cells. If earwax gets stuck, or impacted, it can also contain white blood cells and is more likely to have bacteria or fungus growing in it. In one study, all samples of earwax from patients who often have blockages showed signs of fungus, with bacteria also present in some cases.
Your ear naturally makes earwax. However, if you often put things in your ear, like cotton swabs, hearing aids, or earbuds, your ear might make more earwax or the composition might change. Similarly, using cotton swabs to relieve itching can lead to more earwax and even worsen the itchiness.
Why do People Need Cerumen Impaction Removal
Cerumen is the medical term for earwax. Though it’s normal to have some earwax, too much can cause problems. It can lead to hearing loss, a feeling of stuffiness, itchiness, dizziness, a buzzing or ringing sound (tinnitus), or ear pain. Doctors might need to remove the earwax if it’s causing symptoms or if it’s blocking the ear canal and making it hard for them to check for other problems. Removal of earwax can also be necessary for certain hearing tests. Earwax buildup can make it tricky to monitor other ear issues, such as cholesteatoma, which is an abnormal growth of skin in the ear. Some people who have had ear surgery for cholesteatoma need to have their earwax removed regularly.
But in some cases, earwax doesn’t need to be removed. If a person isn’t having any symptoms, they can usually leave it alone. This is because earwax has certain benefits. It can help fight off bacteria, protect the ear, and keep it moist. Doctors may recommend simply observing the situation, especially if it seems like it’s not causing any problems. However, for young children, elderly people, and those with mental health or cognitive issues, removal of earwax might still be necessary. This is because they might have trouble expressing or noticing any symptoms they’re having, which can worsen their quality of life.
When a Person Should Avoid Cerumen Impaction Removal
There aren’t really any hard rules against removing earwax, but it’s crucial to be careful in some situations. The process can be a little risky in people with conditions like HIV, diabetes, or in people who’ve had organ transplants, because their immune systems are weakened. They might get infections or complications from removing earwax manually, or by hand.
For example, people with diabetes often have a higher pH in their earwax, which means infections from bacteria are more likely. Because their immune systems are weaker, even minor injuries can become infected, so it’s important to be gentle and careful when removing earwax. This group of people can also develop a dangerous condition, called malignant otitis externa, which can seem like they just have stubborn, impacted earwax or small growths in the ear.
It’s also key to be careful with people who take blood thinners regularly, because they can bleed or bruise more easily. Washing out the ear to remove earwax should not be done unless the eardrum is seen clearly as to avoid any chances of it being torn or punctured.
Earwax-dissolving substances can be used for removing earwax and are generally safe, but there are exceptions. They should not be used if someone has a punctured eardrum or has had ear surgery, including the placement of a small tube in the eardrum to help drain fluid. Some people may also react to these substances with local skin irritation or a rash. If used for a long time, it can increase the risk of developing ear infection.
Equipment used for Cerumen Impaction Removal
If you have earwax that needs to be removed, and you can cooperate with the procedure without having any unusual ear structures, a doctor or nurse will generally use an otoscope, which is a special tool for viewing the inside of your ear, and a cerumen curette, another tool specifically designed for removing earwax. Sometimes, they may also use a syringe to gently wash out the earwax with a saline solution.
If the earwax is extremely soft or very hard, other tools may have to be used. These could include a fine suction tip (like a 5 Fr Frazier tip or something similar), a right-angle hook, or alligator forceps (see Image. Cerumen Removal, Instruments).
If your earwax removal gets more complicated and requires more advanced tools, a microscope that’s designed for operations and an otologic speculum, which is used for viewing deeper into the ear, might be required. At this stage, an ear, nose, and throat specialist (known as an otolaryngologist) or a technician trained in ear, nose, and throat procedures is typically needed.
Who is needed to perform Cerumen Impaction Removal?
An earwax removal can be conducted by a variety of healthcare providers, like an emergency doctor, your regular doctor, a nurse, or a healthcare technician. For some cases where the structure of the ear is a bit unusual due to factors like birth defects, injuries, surgeries, or a tumor, you might need to see a specialist known as an otolaryngologist (an ear, nose, and throat doctor) or a technician trained in this field.
In some situations, such as in children or individuals with cognitive difficulties, it might be necessary to use general anesthesia, which puts you to sleep to ensure you don’t move during the procedure to maintain safety of the ear. This also helps lower the risk of causing harm to the parts of the ear that are outside and inside the ear canal. However, for smaller kids needing earwax removal, an option could be to wrap them in a secure, swaddling blanket (sometimes called a ‘papoose’) to keep them still instead of putting them under anesthesia or sedation. But keep in mind, calming such patients usually takes effort and often involves the help of a parent or an assistant helping the doctor.
Preparing for Cerumen Impaction Removal
Before going through with earwax removal, it’s important for patients to understand what’s going to happen. This is primarily to make sure patients stay still and avoid any injury to their ears during the procedure. Just like in any medical procedure, it’s important to be aware there are some risks involved which could include pain, bleeding or even causing damage to parts of the ear leading to potential hearing loss.
Some patients may be more sensitive than others, especially as the skin of the ear canal can become more sensitive the closer it gets to the eardrum, which is very sensitive to pain even with just a light touch. Also, there’s a nerve called Arnold’s nerve in the ear that, when stimulated, might make some people cough or even gag. If this happens, doctors are prepared and know to quickly remove the instruments from your ear. Patients should be aware this reaction could potentially occur.
How is Cerumen Impaction Removal performed
There are three commonly recommend methods to remove ear wax when it becomes a problem: ear drops, washing out the ear, and physical removal.
Ear drops, also known as cerumenolytic agents, are liquids that help thin and soften ear wax until it breaks apart or dissolves. These can be water-based or oil-based. You’ve probably heard of the ingredients found in water-based ear drops such as hydrogen peroxide and sodium bicarbonate. If they’re oil-based, it could include oils you have in your kitchen like peanut, olive, and almond oil. Most of these are readily available over the counter. The usual dosage is up to 5 drops one to two times a day for three to seven days. Some doctors might prescribe an ear drop like carbamide peroxide. This kind of drop works by releasing oxygen which helps to soften the wax and support its natural journey out of your ear. It also provides a small antibacterial effect.
Another way to remove troublesome ear wax is through irrigation, or washing out the ear. Some methods include using warm water alone or combining an equal mix of water and hydrogen peroxide, which is then syringed into the ear with a basin placed underneath. The mix needs to be similar to body temperature because too hot or too cold can cause discomfort and dizziness. This happens when the fluid creates imbalance in part of your ear called the semicircular canals, more commonly if you have ear tubes or a hole in your ear drum.
There are also different types of tools that can be used for ear irrigation. For instance, an oral jet irrigator with a modified tip can be used. This method is generally inexpensive and safe, but it can potentially cause accidents, including ear drum perforation. Electronic irrigators are also an option. However, it’s good to note that manual removal, especially in people over 70, has been found to be more efficient than ear irrigation.
The last recommended method is manual removal. This involves the use of specialized instruments like a metal or plastic loop, spoon, curette, or alligator forceps that a healthcare provider uses to physically remove the ear wax. Some of the tools can have lit tips for better visualization. This method has a lower risk of infection as it doesn’t expose the ear canal to moisture, but it does carry a small risk of puncture and local trauma. Manual removal does require a higher level of skill and patient cooperation, especially if the patient has structural peculiarities in their ear anatomy.
In order to prevent future ear wax build-ups in those who experience this issue more than once a year, applying mineral oil to the outer ear canal for around 10 to 20 minutes weekly has been suggested. It’s also recommended for those using hearing aids to take them out for about 8 hours a day to reduce ear wax build-up.
Possible Complications of Cerumen Impaction Removal
There are many products available in stores that claim to help remove earwax, but it’s important not to buy or use them without advice from a doctor. One common item people often use to remove earwax is a cotton swab, but this can actually push the wax deeper into the ear or even puncture the eardrum, which is a thin layer of tissue separating the ear canal from the middle ear.
Another method people might try at home is ear candling. This involves placing a hollow tube covered in beeswax into the ear canal and lighting the other end on fire. The idea is that the heat from the flame will create a suction effect that pulls the earwax out. However, research shows that this method doesn’t actually work and can potentially cause injuries.
Because of these risks, the U.S. Food and Drug Administration, which is responsible for protecting public health by ensuring the safety and effectiveness of drugs and medical devices, strongly advises against using ear candles or similar devices.
What Else Should I Know About Cerumen Impaction Removal?
It’s important not to mistakenly blame earwax buildup for symptoms that could actually be signs of other conditions. Earwax, or cerumen, can build up and block the ear, a condition known as cerumen impaction. This blockage can cause a variety of symptoms including ear pain, ringing in the ear (tinnitus), dizziness, hearing loss, a feeling of fullness in the ear, itching in the ear, and the sensation of a foreign body in the ear. However, many other conditions can also cause these symptoms.
Once the blockage is removed, if you still have symptoms, your doctor may want to check for other conditions that could be causing them. These could include problems with the tubes that connect your middle ear and throat (Eustachian tube dysfunction), an infection of the middle ear (otitis media), a bone growth disorder in the ear (otosclerosis), sensorineural hearing loss (a type of hearing loss where the root cause lies in the inner ear), issues with the joint connecting your jaw to your skull (temporomandibular joint syndrome), and upper respiratory tract infections like the common cold. If symptoms persist, doctors can carry out further tests to identify these conditions.
