Impacted wax
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Impacted wax refers to the accumulation of cerumen (earwax) in the external auditory canal, leading to symptoms such as hearing loss, discomfort, and tinnitus.
Aetiology
- Excessive cerumen production: associated with genetic factors.
- Use of cotton buds or hearing aids: pushing wax deeper into the ear canal.
- Narrow or hairy ear canals: predispose to accumulation.
- Frequent use of earplugs or headphones: affecting natural wax migration.
Pathophysiology
- Cerumen is normally produced to protect and clean the ear canal.
- Failure of natural migration leads to wax build up and occlusion.
- Impaction can cause conductive hearing loss and irritation.
Risk Factors
- Frequent use of cotton buds.
- Use of hearing aids or earplugs.
- Genetic predisposition to excessive wax production.
- Aging (wax becomes drier and harder).
Signs and Symptoms
- Hearing loss: typically conductive and gradual.
- Tinnitus: buzzing or ringing in the ear.
- Ear discomfort: sensation of fullness or blockage.
- Dizziness: occasionally due to pressure effects on the tympanic membrane.
Investigations
- Otoscopy: confirms presence of impacted cerumen.
- Pure tone audiometry: assesses degree of conductive hearing loss if required.
Management
1. Conservative Management:
- Avoidance of cotton buds: prevents further impaction.
- Self care with cerumenolytics: olive oil, sodium bicarbonate drops, or hydrogen peroxide based drops.
2. Medical Management:
- Ear irrigation: performed with warm water or saline if cerumenolytics fail.
- Manual removal: using a curette or microsuction by a healthcare professional.
3. Referral:
- ENT specialist: if recurrent impaction, failed removal, or suspicion of secondary pathology.
- Audiology: if hearing impairment persists after wax removal.