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3.01 Cerumen Impaction (Ear Wax Blockage)


Presentation

The patient may complain of "wax in the ear," a "stuffed up" or foreign body sensation, pain, itching, decreased hearing, tinnitus, or dizziness. On physical examination, the dark brown, thick, dry cerumen, perhaps packed down against the ear drum, where it does not occur normally, obscures further visualization of the ear canal.

What to do:

What not to do:

Discussion

This technique virtually always works within 5-10 squirts. If the irrigation fluid is at body temperature, it will soften the cerumen just enough that it floats out as a plug. If the fluid is too hot or cold it can produce vertigo, nystagmus, nausea, and vomiting.
A conventional blood-drawing syringe, fitted with a butterfly catheter, its tubing cut l cm from the hub, seems to work better than the big chrome-plated syringes manufactured for irrigating ears. An alternative technique is to use a WaterPik. Cerumen spoons can be dangerous and painful, especially with children, for whom this irrigation technique has proven more effective in cleaning the ear canal to provide for assessment of the tympanic membrane.
Cerumen is produced by the sebaceous glands of the hair follicles in the ear canal, and naturally flows outward along these hairs. One of the problems with ear swabs is that they can push wax inwards away from these hairs and against the ear drum, where it can then stick and harden. Patients may ask about "ear candles" to remove wax, but these are also not very effective compared to the technique above.

References

Robinson AC, Hawke M: The efficacy of ceruminolytics: everything old is new again. J Otolaryngol 1989;18:263-267.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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