- Elizabeth A Dinces, MD
Elizabeth A Dinces, MD
- Associate Professor of Clinical Otolaryngology
- Albert Einstein College of Medicine
Cerumen, commonly known as ear wax, is a hydrophobic protective covering in the ear canal. It acts to shield the skin of the external canal from water damage, infection, trauma, and foreign bodies [1,2]. Accumulation of cerumen is usually asymptomatic but can occasionally cause bothersome symptoms, such as hearing loss and ear discomfort.
This topic will focus on the indications and techniques for cerumen removal.
Cerumen accumulation can affect up to 6 percent of the general population and a much higher percentage of persons with cognitive impairment [3,4]. Excessive or impacted cerumen is present in approximately 1 in 10 children, 1 in 20 adults, and 1 in 3 older adults [2,5]. In the United States, cerumen accumulation leads to 12 million patient visits and 8 million cerumen removal procedures annually .
Cerumen is found in the external auditory canal (EAC), which begins at the meatus of the auricle and ends at the tympanic membrane (figure 1) . The lateral one-third of the EAC (cartilaginous EAC) consists of hair and glandular-bearing skin on top of fibrocartilaginous tissue. The sebaceous and ceruminous glands within the skin appendages found in the cartilaginous EAC are responsible for the components of cerumen. The medial two-thirds of the EAC (bony EAC) consist of thin skin adherent to the periosteum of the temporal bone. The canal narrows in most individuals at the isthmus, which is located at the junction of the bony and fibrocartilaginous portions of the canal . Cerumen trapped medial to the isthmus tends to become impacted and cause hearing loss.
At the most medial end of the external canal is the tympanic membrane. The lateral layer of the tympanic membrane consists of keratinizing squamous epithelium that is in continuity with the epithelium of the external canal [9,10]. Lateral epithelial migration allows for removal of sloughing squamous epithelial cells. Further description of the ear canal and discussion of its relationship to external ear canal disease are presented elsewhere. (See "External otitis: Pathogenesis, clinical features, and diagnosis", section on 'Anatomy' and "External otitis: Pathogenesis, clinical features, and diagnosis", section on 'Pathogenesis and risk factors'.)
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- CERUMEN ACCUMULATION AND IMPACTION
- CLINICAL PRESENTATION
- CERUMEN REMOVAL
- Indications for removal
- Removal methods
- - Cerumenolytics
- - Irrigation
- - Manual removal
- - Other methods
- PREVENTION OF CERUMEN ACCUMULATION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS