Earwax and Foreign Body in Ear

& Nose
 Earwax
• Known as cerumen, is a yellowish, waxy
substance secreted in the ear canal of humans
and many other mammals.
• It plays an important role in the human ear canal,
assisting in cleaning and lubrication.
• Provides some protection from bacteria, fungus,
and insects.
• In normal circumstances, excess wax finds its way
out of the canal and into the ear opening
naturally, and then is washed away.
 Excess earwax
• May get hard and block the ear
• You can accidentally push the wax deeper,
causing a blockage.
• Wax buildup is a common reason for
temporary hearing loss.
 Causes of earwax buildup
• Use of ear buds (This is the most common cause
of ear wax problem)
– In an attempt to clean the ear, wax is pushed in deep
into the ear canal and
• Use of pins/ match sticks/rolled napkin corners
• Using ear plugs
• Hearing aid users
• Structural variations in ear canal producing
narrow/collapsed outer ear canal
• Swellings in outer ear canal
– an osteoma
These can prevent earwax from coming out of the ear canals
and cause blockages.
Signs and symptoms of earwax buildup
• The appearance of earwax varies from light yellow to dark
brown.
• Signs of earwax buildup include:
– Ear Blockage
– Ear Fullness
– Ear Pain
– Ear Discomfort
– Ear Itching
– Sudden or partial hearing loss, which is usually
temporary
– Dizziness
– Tinnitus which is a ringing or buzzing in the ear sudden
or partial hearing loss, which is usually temporary
 Complication of earwax
• Unremoved earwax buildup can lead to infection.

• The symptoms of infection:

– Severe pain in your ear
– Ear discharge
– Fever
– Coughing
– Persistent hearing loss
– An odor coming from your ear
– Dizziness or headache
– Itching of outer ear
 Treatment of earwax
• Cerumenolysis
• Syringing
• Instrumental Manupulation
 Cerumenolysis
• To soften wax before its removal.
• Using a solution known as a cerumenolytic agent
which is introduced into the ear canal.
• The most common home-remedy for this purpose is
olive oil.
• Other commercially available and common
cerumenolytics include:
– mineral oil
– hydrogen peroxide
– carbamide peroxide
– baby oil
– glycerin
 Syringing

• Another way to remove earwax buildup is by irrigating

the ear.
• Never attempt to irrigate your ear if you have an ear
injury or have had a medical procedure done on your
ear.
• Irrigation of a ruptured eardrum could cause hearing
loss or infection.
• Never use products that were made for irrigating your
mouth or teeth.
• They produce more force than your eardrum can safely
tolerate.
• To properly irrigate your ear, follow the
directions provided with an over-the-counter
kit, or follow these steps:
– Stand or sit with your head in an upright
position.
– Hold the outside of your ear and pull it gently
upward.
– With a syringe, send a stream of body-
temperature
water into your ear. Water that’s too cold or too
warm can cause dizziness.
– Allow water to drain by tipping your head.
 Instrumental Manupulation
• Should always be done by skilled hands
• Cerumen hook, scoop or Jobson-Horne
 Foreign Body in Ear
• Condition where something is present in the
ear that is not normally there.
– Common in children especially toddlers
– Although they can be found in adults.
 Causes of foreign body in ear
Organic Inorganic
• Non living • Bead
– Sponge • Metal
– Eraser • Stone
– Paper • Plastics toys
– Wood • Button battery
– Cotton buds
• Living
– Maggot
– Nuts
– Beans
– Worms
 Sign and symptoms
• Ear pain
• Ear discharge
• Loss of hearing in one ear
• Reduced hearing
• Fretfulness of child
• Child scratching at the ear
 Investigation
• Otoscopy
 Treatment
• Cerumenolysis
• Syringing
• Instrumental Manupulation

(SAME AS EARWAX TREATMENT)

 Complication
• Acute complications of ear foreign body
removal include:
– Canal abrasions, bleeding, infection.
– Perforation of the tympanic membrane.
– Otitis externa / otitis media
– Foreign body granuloma
– Tetanus may occur from sharp infected
foreign bodies
 Foreign Body in Nose
• Often seen in the emergency department,
nasal foreign bodies (NFBs) are most often a
pediatric phenomenon.
• However, adults, particularly those with
mental retardation or psychiatric illness, can
also fall victim.
• NFBs can cause mucosal damage and, if they
dislodge into the airway, can even prove fatal.
 Common items that children put in
their noses include:

• small toys
• pieces of eraser
• tissue
• clay (used for arts and crafts)
• food
• pebbles
• dirt
• paired disc magnets
• button batteries
 Symptoms of foreign body in nose
• Difficulty breathing through the affected
nostril
• Feeling of something in the nose
• Foul-smelling
• Bloody nasal discharge
• Irritability, particularly in infants
• Irritation or pain in the nose
 Investigation
• Patient history
• Rhinoscopy
• Radiograph
– Computed tomography (CT) scanning or other
advanced imaging modalities may be useful when the
differential diagnosis includes, for example, tumor or
sinusitis.
– Ingestion or aspiration of a foreign body, the patient
should be evaluated with chest/abdominal
radiography.
• An aspirated, radiolucent foreign body may be inferred by post-
obstructive air trapping, and an ingested foreign body will show up if it
is radiopaque, as most ingested foreign bodies are.
 Treatment
• Give anaesthesia – general or local
• Visualization
• Removal
 Complications
• Nasal Infection
• Sinusitis
• Rhinolith
– Stone Formation
• over the Foreign Body
• Inhalation into the
– Tracheobronchial Tree.
Foreign body is shown in the left nasal cavity with
surrounding inflammation.
• View of the nasal cavity after removal of the
foreign body. Note the rust from screw.
 REFERENCES
• https://www.healthline.com/health/earwax-
buildup
• https://emedicine.medscape.com/article/763
767-overview
• https://www.healthline.com/health/foreign-
body-in-the-nose#treatment