Ear wax

ECOPHARM CPD
Ear wax aka Cerumen

 Is a waxy substance secreted in the ear canal of humans. Ear wax can have many
colors including brown, yellow, red and grey.
 Major components of earwax include: cerumen, produced by modified sweat
gland and sebum, an oily substance, dead skin cells and hair.
 Is produced by the inner 3rd of the ear canal.
Functions of ear wax

 Mechanical protection of the tympanic membrane

 Trapping dirt
 Repelling water
 Contributing to acidic medium to protect against fungal and bacterial infection
Causes

 Air cleaning using ear pads which may also result in a perforated ear drum.

Risk factors
 Patients with congenital anomalies ( narrowed ear canal)
 Hearing aids ( associated with increased wax impaction)
 Elderly ( as glands reduce secreting cerumen)
Clinical Presentation

 Mild conductive hearing loss worsened by trying to clean them

 Mild Discomfort with dull ache (very rarely painful)
Clerking

 Course of symptoms ( hearing loss, is it gradual or sudden)

Hearing loss is gradual in wax impaction.
 Associated symptoms ( dizziness, tinnitus, vertigo, true pain)
Rare is wax impaction associated with the above symptoms
 History of symptoms (trying to clean the ears)
This is a very common practice especially using cotton pads (swabs)
 Use of medicines ( correct use requires referral)
Otic or systemic drugs like aminoglycosides e.g. gentamycin ear drops
in perforated tympanic membrane
Referral points

 Dizziness, tinnitus (associated with inner ear problems)

 Fever and general malaise ( may be otitis media, suppurative otitis
media, malignant otitis media)
 Associated trauma- related conductive deafness, foreign body in the EAM
Non pharmacological treatment

 Movement of the jaw helps in the natural cleaning process of the ears
Treatment (Cerumenolytics)
Note : Although agents used to soften ear wax have limited evidence of efficacy, they are very
safe. They can be given to all patient groups, do not interact with any medicines and can be used in
children. These include:

1. Oil based products e.g. olive oil, turpentine oil, arachis oil, peanut oil,
camphor oil) e.g. cerumol
In between administration a plug of cotton wool, moistened with Cerumol or smeared with petroleum jelly,
should then be applied to retain the liquid.
Cerumenolytics

1. Peroxide base products

Unlike Cerumol, the patient should be advised not to plug
the ear but retain the drops in the ear for several minutes
by keeping the head tilted and then wipe away any
surplus. Patients might experience mild, temporary
effervescence in the ear as the urea–hydrogen peroxide
complex liberates oxygen
Treatment (Cerumenolytics)

3. Ducosate
It emulsifies (binds water content + fat content of wax or binds fat components
together) wax. Making it soft and easy to follow out. It also makes ear syringing easy.
Cerumenolytics
4. Water based e.g. Sodium bicarbonate
Cerumenolytics

5. Glycerin based
6. Sterile water
Direction for use of ear drops in adults
Rational of pulling the ear up and back
wards
(this straightens the canal)
Directions for use of ear drops in
children
Rational of pulling the ear down and
backwards (this straightens the canal)
Patient advise

 The ear drops might, for a short while, increase deafness and the patient should
be warned about this possibility.
 If the symptoms have persistent, the patient may need Ear irrigation or syringing
by a trainined and skilled healthcare provider.
 Syringing in perforated ear drum can force infection into the middle ear and
residual what may lead to other infections of the external ear (fungi and bacteria)