WHAT IS IT?

Abstract VOL: 100, ISSUE: 29, PAGE NO: 30

WHAT IS IT?

- The skin cells lining the outer ear canals include tiny glands, similar to sweat glands, which produce the wax (cerumen).

- The wax slowly works its way to the outside, taking trapped dirt and dust with it.

- Most people’s ears clear the wax as fast as it is produced but if it builds up it can cause problems.

- Impacted wax in the ears is a common cause of deafness, discomfort, and sometimes noises in the ears.

- Earwax can be a potential source of transmission of hepatitis B (Kalcioglu et al, 2004).

PREVALENCE

- Impacted earwax is common.

- It is one of the most common causes of hearing loss.

- Just under one-third of older people experience the problem.

- In the UK thousands of people every week have earwax removed. The chances of wax accumulating are increased by use of hearing aids and cotton buds.

CAUSES

- Wax may be produced in increased quantities that the ear is unable to clear. Persistent exposure to loud noise can induce this response as can a viral infection.

- Ear canals can be narrow or lie at an angle. This can slow the natural passage of the wax leading to a build-up.

SYMPTOMS

- Increased difficulty in hearing.

- Pain in either or both ears.

- Hearing a noise or a ringing.

- An awareness of something blocking up the ear’s canal or a feeling of fullness.

- Temporary deafness or pain in the ear(s) after swimming or having a bath or shower (because water causes the plug of wax to swell).

EFFECTS OF IMPACTED WAX

- Hearing loss.

- Earache.

- Itchiness in the ear.

- Reflex cough.

- Dizziness or vertigo.

- Tinnitus.

- Some people are asymptomatic.

REMOVING WAX

Earwax can be removed in a number of different ways:

- Wax softeners such as olive oil or over-the-counter proprietary brands are often effective;

- Irrigation or syringing using an electric jet irrigator is the most common procedure;

- Mechanical methods such as suction, using probes, or forceps with direct vision.

CONTRAINDICATIONS TO SYRINGING

- Past or present perforation of the ear drum.

- Ear infection.

- Presence of a grommet.

- History of ear surgery.

- Patients who are unable to cooperate such as young children or those who are confused.

COMPLICATIONS OF SYRINGING

Adverse effects are common and can include:

- Perforation of the ear drum;

- Damage to the external canal;

- Pain;

- Deafness;

- Vertigo.

FURTHER READING

Aung, T., Mulley, G.P. (2002)10-minute consultation: removal of ear wax. British Medical Journal; 325: 27.

WEBSITES

For information on earwax removal for parents of young children:

http://family.go.com/raisingkids/child/health/childhealth/ dony79enc_earwax

NHS Direct’s health encyclopaedia: www.nhsdirect.nhs.uk/resourceindex