Cerumen:  Earwax

Produced by seromucinous glands. 

The secretions combine with desquamated cells and debris to form wax. 

Buildup is frequently due to dust, hair spray and other environmental debris.  Most often it is due to cotton swabs.

Production appears to be under the influence of circulating catecholamines. 

A change to overproduction of wax is often found in patents with essential fatty acid deficiency and can also indicate atherosclerosis [perform SMAC].

Warm humid air thins the wax and more may be noted in the area of the pinna. 

It does not indicate an increased production. 

 

Some people are obsessive about earwax.  Tell them to relax.

 

Purpose of cerumen:

Antifungal, bactericidal, warms and humidifies.

 

 

Appearance of cerumen: 

Shiny (b/c wax) and lumpy (due to wave action)… this is a constant.

The color…………. is not a constant.

            The color darkens as it ages and dries.  It remains shiny.

 

 

White                           new and water logged

 

Pale yellow                   new

 

Golden                          been around awhile

 

Blood-colored                been around even longer

                                    - Don’t mistake for blood.  This forms a wall.  Blood pools.

- Can tear the skin if don’t soften this or the darker ones

before removing them

 

Scab-colored                 been around so long it should be registered with the post office

- Don’t mistake these and the darker ones for tumors

 

Brown                          its time for it to get a job

 

Black                            oh, brother.

- Don’t mistake for a tumor or perforation

Removal of cerumen

 

Syringe:  do not perform if there is a chance of a perforated drum

Seat the patient

Drape the patient and place a bowl under the ear

Use tap water at body temperature

Pull the pinna to straighten the EAM

Direct the stream to the superior wall of the EAM

[Never at the TM]

Examine the canal afterward

A water pick may be used. 

 

Curette or spoon:  if the patient can be controlled and you are sure not to touch the walls of the EAM.  It is highly innervated with sensory nerves and the tissue is very fragile.  Brushing it may cause the patient to cough.  Irritating it or scratching it can cause severe pain. 

Gently remove the majority of the cerumen, without brushing the walls, then flush.

If the cerumen is very dry [blood red to black], then hydrate for 7 to 10 days, minimum, before trying the curette.

 

Hydrating cerumen:  have the patient use one of the following once or twice a day

The patient is side-lying with the involved side up.

Several drops are placed in the ear.  Wait five minutes.  Place a cotton ball in the EAM.

 

Sweet oil [special virgin olive oil- found in OTC section]

One part alcohol and two parts water

Over the counter products

Hydrogen peroxide

1 part 70% peroxide, 2 parts water, 1 part 5% vinegar

 

Candles:  effective for removing wax but can fall into canal and burn the patient

Warms the canal and thins the wax by warming it

The wax moves out

 

Removal of wax by patients:  allow a week

 

The easiest methods to prevention build up: 

Flush the ear in the shower with the stream at an angle or go swimming

Cover ears when using hairspray, etc.

Don’t use cotton swabs or place foreign objects in ears