a build-up of earwax in the ear canal can cause hearing loss and discomfort, contributes to infections, and can exacerbate stress, social isolation and depression (1)
also earwax can prevent adequate clinical examination of the ear, delaying investigations and management; GPs cannot check for infection and audiologists cannot test hearing and fit hearing aids if the ear canal is blocked with wax
excessive earwax is common, especially in older adults and those who use hearing aids and earbud-type earphones
in the UK, it is estimated that 2.3 million people each year have problems with earwax sufficient to need intervention
cerumen (ear wax)
is a complex mixture of lipids
is produced by the sebaceous glands of the external auditory meatus as a means of protecting the epithelial lining of the tract
is made up of epithelial cells, hair, and secretions of the external ear (2)
impacted cerumen
seen in about 4% of primary care patients(2)
commoner in children (2)
in this condition,cerumen, which may be hard, obstructs the auditory canal
risk factors for cerumen impaction are (3):
old age
learning disability
use of cotton swabs in ears
hearing aids
earplugs
clinical features of cerumen (2)
ear discomfort
hearing loss
tinnitus
dizziness
chronic cough
diagnosis
by direct visualization using an otoscope (2)
management
consider ear irrigation using an electronic irrigator, microsuction or another method of earwax removal (such as manual removal using a probe) for adults in primary or community ear care services if:
the practitioner (such as a community nurse or audiologist):
has training and expertise in using the method to remove earwax
is aware of any contraindications to the method
the correct equipment is available
when carrying out ear irrigation in adults (1):
use pre-treatment wax softeners, either immediately before ear irrigation or for up to 5 days beforehand
if irrigation is unsuccessful:
repeat use of wax softeners or
instil water into the ear canal 15 minutes before repeating ear irrigation
if irrigation is unsuccessful after the second attempt, refer the person to a specialist ear care service or an ear, nose and throat service for removal of earwax.
possible complications of wax removal are:
pain,otitis externa,perforation of tympanic membrane, tinnitus,dizziness,syncope,cough, cardiac arrest (2)
golden advice to patients
"Never put cotton swabs or other objects into the ear canal" (3)
Notes (4):
manual water-filled syringes are no longer recommended in the UK because of potential damage to hearing and risk of litigation (4)
contraindications to use of an electronic irrigator include
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