Cerumen Impaction

Cerumen Impaction

Recently, there has been a rise in ear cleaning carried out by non-professional staff in public places such as barbershops. This ear cleaning action can risk causing earwax to be pushed further in or even cause injuries and other infections if it is not done with the right procedure. In fact, cerumen or earwax has the function of protecting the ear, plus its wax-like consistency protects the ear from the entry of dirt such as dust or even insects. 1 However, excessive production of cerumen and interference with the natural process of cleaning earwax causes blockage of the ear canal. This condition is called cerumen impaction which can cause symptoms in patients.

 

Cerumen Composition

Cerumen is composed of a combination of dead skin cells (keratin) originating from the skin tissue lining the ear canal and secretions from the sebaceous and ceruminous glands. The resulting secretion of fats and peptides from the glands gives the cerumen a more oily and soft consistency. Whether cerumen is hard or soft really depends on the composition that makes it up, where cerumen that is dominated by keratin tends to be harder. 1,2 Therefore, there are also two types of earwax, dry and wet. Wet earwax is generally light or dark brown in color with a sticky, glue-like consistency. Meanwhile, dry earwax is generally gray and brittle.

 

Symptoms and Causes of Cerumen Impaction

Cerumen impaction causes symptoms of itchy ears, a feeling of fullness in the ears, decreased hearing, ringing in the ears, or pain in the ears. Many factors can cause cerumen impaction. First, excessive cerumen production exceeds the ear's ability to clean earwax. This dirt is cleaned by the ear through the mechanism of epithelial cell migration with the help of jaw movements when chewing. Second, the presence of an obstruction that blocks the migration process increases the risk of cerumen impaction. This obstruction often comes from using ear plugs and cotton buds which risk pushing cerumen deeper into the ear canal. Finally, changes in ear anatomy due to other diseases such as infections can also cause cerumen impaction.

 

Handling

Cerumen impaction can be treated by administering cerumenolytic drugs which function to soften the cerumen so that it is easy to remove from the ear canal. Softer cerumen will make extraction easier and minimize injury to the ear canal due to efforts to remove the cerumen. Other treatments include ear irrigation to remove cerumen which is carried out by medical personnel such as general practitioners or ENT specialists. If both attempts to remove hardened cerumen fail or do not have complete equipment, it is better to immediately refer you to an ENT specialist for extraction. Avoid attempts to remove cerumen using sharp objects because this can risk injuring the ear canal or even perforating the eardrum. 3 Consult a doctor regarding the need for regular cleaning on a regular basis to avoid repeated impaction of cerumen.

 

 

 

Reference

1.Horton GA, Simpson MTW, Beyea MM, Beyea JA. Cerumen Management: An Updated Clinical Review and Evidence-Based Approach for Primary Care Physicians. Journal of Primary Care & Community Health. 2020;11. doi:10.1177/2150132720904181

 

2. J.F. Guest, M.J. Greener, A.C. Robinson, A.F. Smith, Impacted cerumen: composition, production, epidemiology and management, QJM: An International Journal of Medicine, Volume 97, Issue 8, August 2004, Pages 477–488,https://doi.org/10.1093/qjmed/hch082

 

3.Meyer F, Preuß R, Angelow A, Chenot J-F, Meyer E, Kiel S. Cerumen Impaction Removal in General Practices: A Comparison of Approved Standard Products. Journal of Primary Care & Community Health. 2020;11. doi:10.1177/2150132720973829