Impacted Wax or Cerumen

Impacted Wax (Cerumen)

Definition: A mixture of secretions from sebaceous and ceruminous glands, combined with hair, desquamated epithelial debris, keratin, and dirt.

Composition & Physiology

  • Sebaceous Glands: Secrete fluid rich in fatty acids.
  • Ceruminous Glands: Modified sweat glands; secrete lipids and pigment granules.
  • Location: Both open into the space of the hair follicle (Outer cartilaginous part).
  • Formation: Secretions mix with keratin shed from TM and deep bony meatus.

Functions:

  • Protective: Lubricates canal, entraps foreign material.
  • Antimicrobial: Acidic pH (Bacteriostatic & Fungistatic).

Aetiology of Impaction

Normally, wax dries up and is expelled by jaw movements. Impaction occurs due to:

  • Excessive secretion (individual variation in sweating).
  • Narrow or tortuous ear canal.
  • Stiff hair in canal.
  • Obstructive lesions (e.g., Exostosis).

Clinical Features

  • Hearing Loss: Conductive deafness or "blocked" sensation.
  • Tinnitus & Giddiness: Due to pressure against Tympanic Membrane.
  • Reflex Cough: Stimulation of Auricular branch of Vagus.
  • Sudden Onset: Often after bathing/swimming (Water enters → Wax swells).
  • Wax Granuloma: Ulceration of meatal skin due to long-standing impaction.

Treatment

1. Syringing (Irrigation)

Patient Position: Seated with towel around neck. Head slightly tilted over kidney tray.

ear syringing

Illustration to show how a jet of water expels wax or a foreign body

Pull Pinna Upwards & Backwards
↓
Direct Stream along Postero-superior Wall
↓
Pressure builds deeper to wax → Expels it out
Important Precautions:
  • Temperature: Must be Body Temp (37°C). If too hot/cold → Caloric stimulation → Vertigo/Fainting.
  • Contraindication: History of discharge or Perforation. (Can reactivate quiescent Otitis Media).
  • Force: Excessive force can rupture a weakened TM.

Post-Procedure:

  • Inspect canal to ensure all wax is removed.
  • Dry canal with a pledget of cotton.
  • If ulceration is present: Apply antibiotic ointment.

2. Instrumental Manipulation

  • Indication: Skilled hands under direct vision.
  • Tools: Cerumen hook, scoop, Jobson-Horne probe.
  • Method: Create space between wax and wall → Drag out in one piece. If it breaks, use syringing.

3. Wax Softeners (Ceruminolytics)

Used if wax is too hard to syringe. Instill 2-3 times/day for a few days.

Agent Details
Soda Glycerine 5% Sodium Bicarbonate + Glycerine + Water.
Oils Liquid paraffin, Olive oil.
Chemicals Hydrogen peroxide, Paradichlorobenzene 2%.
📚 Source: ENT Dhingra

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