Cerumen or Wax Impaction

The skin on the outer half of the ear canal has special glands that produce earwax (cerumen). Earwax is a protective secretion of the ear, which repels water and traps dust, sand particles and insects to stop them injuring the ear. Earwax helps keep the ear canal clean and lubricated and helps to protect from some bacteria and fungal infections by acidifying the canal. Normally a small amount of wax accumulates and then dries up and falls out of the ear removing any unwanted particles. If there is excess earwax it can press against the eardrum and/or occlude the external auditory canal and impair hearing. Excess earwax is termed cerumen impaction. Earwax is produced in the outer third of the cartilaginous portion of the ear canal. Inserting objects into the ear increases the risk of impaction. This includes cotton buds and hearing aids. Impaction tends to occur when attempts are made to remove the earwax, which instead pushes the earwax toward the eardrum. It can be made worse by swimming and showering as water moistens and expands the earwax. Uncommonly, impaction can also occur from excess earwax production (ceruminosis) and from an abnormally shaped eardrum.

Symptoms

Some common symptoms of cerumen impaction include itch, ringing in the ears (tinnitus), a sensation or fullness or tingling in the ear. Normally the condition is painless unless the earwax is in direct contact with the eardrum or injury to the external canal. Hearing loss can occur but unless the ear canal is completely obstructed, it may not be noticeable. If the earwax is in direct contact with the eardrum it may cause dizziness or disturb balance.

Statistics

Cerumen impaction affects around 2-6% of the general adult population at any one time. It is more common in children. Cerumen impaction is found in up to 30% of elderly patients with hearing loss.

Diagnosis

Diagnosis is usually made by examining the ear canal and eardrum with an otoscope (a microscope with a light source used to look into the ear).

Treatment

The earwax may be removed if it is causing hearing loss, pain or blocking the view of the eardrum through an otoscope. Earwax can be safely removed by a doctor using a variety of methods. A softening agent may be used before a procedure to make the wax easier to remove. The wax can then be manually removed by a doctor with a steady hand and a spoon shaped surgical instrument. The aim is to remove the earwax in one piece. Most commonly earwax is removed by irrigation, also known as syringing, using a warm water ear lavage. In this process the external ear is pulled up and back and the ear canal gently irrigated with a syringe from the roof of the canal. The aim is to allow any debris to run out of the ear along the floor of the ear canal. Water at body temperature is used to prevent dizziness. The doctor may also add in acetic acid to prevent infection or hydrogen peroxide or benzalkonium chloride, which act like detergents and prevent wax from sticking to the ear canal. Finally earwax can be removed by suction. An otoscope is used so that the area can be seen and a suction device carefully used to remove pieces of wax. This can occasionally lead to infection in the outer ear or if the eardrum is damaged, also involving the middle ear. It is always best to seek medical help to remove earwax. Trying to remove earwax yourself with a cotton bud puts you at risk of damaging the eardrum which can cause bleeding and infection. Some earwax softening agents, available from the chemist may relieve the impaction. To prevent cerumen from impacting, wipe the outer opening of the ear with a damp washcloth folded over the index finger. 2-3 drops of mineral oil in ear once a week or equivalent otic solution will also prevent build up. Remember to dry your ears well after swimming. Do not use cotton buds deep inside your ear.

The information contained on this page is not meant to be a substitute for the advice from the surgeon or other clinical specialist. This is not a complete discussion of ear disease and is not a complete explanation of the risks of surgery and/or treatments.