Sunday, November 30, 2008

Ear Wax

What is ear wax?

Ear wax is the yellow greasy material in the external auditory canal. It's a mixture of secretions of the ceruminous and sebaceous glands and desquamated epithelium.
It is normally present in our ears and is expelled outside by the movement of the epithelium, in the form of flakes.

Functions of wax in the ear :
1-lubrication for the skin lining the external auditory canal.
2-Contains enzymes that kill bacteria and harmful organisms.
3-Acts as a filter against dust and sand as they stick to it.

But wax in large amounts, accumulates in the canal and may block it causing hearing loss and fullness.

Why is wax accumulated?
-It may accumulate due to abnormal over production
-Or due t narrow external canal.
-May be caused by attempts of the patient to remove the wax by himself using cutton beds leading to pushing of the wax deeper into the external auditory canal.

Symptoms of wax accumulation :
-The commonest sympton is hearing loss (conductive deafness)
-It may affect one or both ears.
-Sense of fullness and tinitus.

On Examining the ear, the physician finds a brownish mass in the external auditory canal.

Treatment and removal :
-Ear wash :
It shuould be done by a physician, avoid any violent unskilled attempts by the patient.
-By special instruments.

Steps of ear wash (for doctors) :
-Make sure that your syringe and other instruments are sterile and clean.
-Ask the patient no to make any sudden movements.
-Hard wax is softened first by glycerine sodium bicarbonate before removal.
-Pull the auricle upwards and backwards (to straight the canal).
-Direct the nozzle upwards and backwards in the external auditory canal and be gentle and careful during the wash.

Contraindications to ear wash :
-Drum perforation or the presence of a fistula between the middle and inner ear.
-Inflammation of the external auditory canal (it's called otitis externa)
-Large, impacted or vegetable foreign bodies (in case of foreign bodies inside the ear)

Possible complications of ear wash :

-Reflex syncope or cough caused by stimulation of the vagal nerve.
-Trauma due to sudden movement or lack of skill.
-Vertigo and nystagmus in case of using cold water ( use warm water of body temprature)
-Infection due to unsterile water or instruments.