Cerumen - Ear Wax

Cerumen, commonly known as ear wax, is a substance produced by the ear glands, which protects the skin from the external ear canal from water damage, trauma, foreign bodies, infections, etc.

The build-up of earwax is usually asymptomatic, but may occasionally cause troublesome symptoms, such as hearing loss, itching, discomfort, or a blocked ear.

In this text we will explain what is cerumen, what are the symptoms of clogged ear, what are the causes of cerumen impaction and how to remove wax from the ear.

Ear wax
Ear wax

What is cerumen?

Cerumen is a substance produced in the ear canal, which is the outermost part of the auditory system, located between the tympanic membrane and the ear hole.

The region closest to the outer ear has ceruminous glands and sebaceous glands responsible for the production of fat and tallow. Ear wax is the result of the blending of this sebum with dirt, peeling skin, bacteria, water and scraps of hair that exist in the ear.

The wax is produced exclusively on the outermost third of the ear and can be found more deeply near the eardrum only if it has been pushed by swabs, staples, a pen cap, or any foreign body introduced into the ear.

Cerumen is important for ear health, as it protects against trauma, dryness and bacteria. Wax has several protective properties, such as water impermeability, presence of antibodies and an acidic pH (combating germs present in the ear), sticky consistency, which helps to cling to tiny foreign bodies, as well as serving as a lubricant for the ear canal. reduces the risk of dryness and injury.

The outer ear is "self-cleaning". Your cells are always renewing from the inside out, which causes the cerumen to be naturally and continuously pushed out of the ear. People tend to think that wax bits outside the ear are a sign of too much cerumen or ear clogged. In fact, this is just the ear working properly to eliminate portions of old wax.

Symptoms of clogged ear

As already explained, wax is not a disease or health problem, so its simple existence does not usually cause any symptoms.

The ear wax problem arises when it is impacted and causes obstruction of the ear canal. In this case the following symptoms may be present:
  • Decreased hearing
  • Clogged ear sensation
  • Itching in the ear
  • Earache
  • Cough
  • Buzz
  • Dizziness

Often, the accumulation of wax in the ear occurs so gradually that the patient does not notice the progressive loss of hearing. It may take years of ear clogging for the individual to begin to notice that something is wrong in their ears.

Why is wax impacted in ear?

One of the most common causes of clogging the ear canal is the use of swabs or other objects to clean the ear. The swab is too large and ends up pushing the wax far more than it can remove. Its frequent use can create a large cork at the bottom of the ear canal, causing the natural process of ear cleansing to be unable to push all of the impacted cerumen.

The normal aging process can also be a risk factor. Older people produce a harder and less lubricated cerumen, which, along with alterations and aggressions to the skin that covers the ear, causes a reduction in the ability to expel the wax.

People with changes in the anatomy of the ear, whether birth, frequent ear infections or trauma, may have a tighter ear canal, which favors impaction of the cerumen.

In some cases, however, we can find no clear reason for the occurrence of ear wax clogging. Some people simply produce more cerumen than the ear is capable of eliminating, being at permanent risk of creating cerumen stoppers.

How to remove ear wax?

The cerumen should be removed whenever the patient has any of the symptoms described above. There are basically three ways to remove excess wax from the ears: ceruminolytics, irrigation, or mechanical removal by the otolaryngologist.

The ceruminolíticos are substances that can be dripped in the ears with the objective to soften the cerumen, facilitating its natural expulsion. One of the most well-known ceruminolytics is Cerumin. Drops of mineral oil can also be used.

The use of ceruminolytics, although simple and sold without prescription in pharmacies, should not be done without guidance from an otolaryngologist. People with eardrum injuries, pain or signs of ear infection should not drip anything without medical advice. There is also the risk of the ceruminolytics being trapped behind the wax plug, causing irritation of the tympanic membrane.

Irrigation is another valid option for removal of the cerumen. The procedure is usually done with a stream of warm serum into the ear with a large 200 ml syringe. The prior use of ceruminolytics helps to soften the wax and increases the effectiveness of the procedure. Irrigation should also not be done in patients with pain, perforation of the eardrum or signs of ear infection.

Although irrigation is a simple procedure, it is safest to avoid using it at home without the assistance of a trained professional as there are risks of tympanic perforation and ear infection if the procedure is done in the wrong way.

Mechanical removal of cerumen is the fastest and most effective method, but it can only be done by an otolaryngologist. The doctor, with special instruments, can see directly the inside of the ear, and can easily remove the excess of impacted wax.

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