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Cerumen

INTRODUCTION

Ear wax, or cerumen, is a hydrophobic protective covering in the ear canal. It acts to protect the skin of the external canal from water damage, infection, trauma, and traps foreign particles and aids in elimination of bacteria [1,2]. The formation of cerumen and indications for and techniques of removal are reviewed here.

ANATOMY OF THE EXTERNAL AUDITORY CANAL

Cerumen is found in the external auditory canal (EAC), which begins at the meatus of the auricle. The EAC consists of hair and glandular-bearing skin on top of fibrocartilaginous tissue for the first lateral one-third (figure 1). The appendages of the skin at the lateral third of the EAC are responsible for the components of cerumen. The skin then becomes thin and adherent to the periosteum of the temporal bone for the medial two-thirds of the canal. The canal narrows in most individuals at the junction of the bony and fibrocartilaginous portions of the canal and again more significantly at the isthmus in the mid-portion of the bony 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 [3,4]. (See "External otitis", for further descriptions of the ear canal and its relationship to external ear canal disease).

COMPOSITION AND APPEARANCE

Cerumen is composed of the secretions of both sebaceous and cerumenous glands located in the lateral one-third of the external ear canal. These secretions mix with desquamated skin, the bacteria of normal skin flora, and occasional depilated hair to form cerumen [5-7]. Water trapped in the ear canal also mixes with cerumen.

Cerumen has a wide range of appearance from almost liquid to rock hard, depending upon the percentage of its different components, time spent in the ear canal (harder cerumen has been present longer), and the amount of desquamated skin. Color ranges from a deep, dark red that can appear black, to off-white. A given individual may have different color cerumen in each ear. The color of the cerumen reflects its composition, but does not necessarily depict normalcy or the health of the external canal. Harder cerumen has an increased tendency to accumulate but does not warrant removal unless there is a specific otologic complaint (see below).
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