CERUMEN ACCUMULATION
Posted by recep on April 2nd, 2009Accumulation of cerumen (earwax) may occur in persons of any age but appears to be more common in the elderly. It is a common cause of sudden tinnitus and hearing loss. The accumulation may be rock-hard and, particularly in older men, may contain a generous admixture of exfoliated hairs. The patient may complain of hearing loss and a feeling of fullness in the ear. Obstruction of the external canal is obvious on examination. Because the adnexal elements responsible for cerumen production are located in only the lateral % of the canal, impaction extending to the medial portion suggests manipulation with instruments such as cotton-tipped applicators.
The cerumen should be removed as gently as possible. In some cases, removal may be accomplished with a cerumen spoon, along with good visualization and an aural speculum. The skin of the external auditory canal can easily be traumatized and is exquisitely sensitive to manipulation. Thus, with hard accumulations, topical therapy with a cerumen-softening agent for several days to a week may be necessary to soften the debris and allow it to be removed atraumatically.
An antibiotic otic solution 4 drops qid for a few days in the affected ear softens the cerumen and quells any smoldering infection. When adequately softened, the cerumen can be easily removed, either with a spoon or by water irrigation. Irrigation is contraindicated if the tympanic membrane is perforated, since it may provoke an infection. To avoid perforating the tympanic membrane, the irrigation force should be gentle and directed along the canal wall, not directly at the eardrum.
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