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Ear wax:
- a build-up of earwax in the ear canal can cause hearing loss and discomfort,
contributes to infections, and can exacerbate stress, social isolation and
depression (1)
- also earwax can prevent adequate clinical examination of the ear, delaying
investigations and management; GPs cannot check for infection and audiologists
cannot test hearing and fit hearing aids if the ear canal is blocked with
wax
- excessive earwax is common, especially in older adults and those who
use hearing aids and earbud-type earphones
- in the UK, it is estimated that 2.3 million people each year have problems
with earwax sufficient to need intervention
- cerumen (ear wax)
- is a complex mixture of lipids
- is produced by the sebaceous glands of the external auditory meatus
as a means of protecting the epithelial lining of the tract
- is made up of epithelial cells, hair, and secretions of the external
ear (2)
- impacted cerumen
- seen in about 4% of primary care patients(2)
- commoner in children (2)
- in this condition,cerumen, which may be hard, obstructs the auditory
canal
- risk factors for cerumen impaction are (3):
- old age
- learning disability
- use of cotton swabs in ears
- hearing aids
- earplugs
- clinical features of cerumen (2)
- ear discomfort
- hearing loss
- tinnitus
- dizziness
- chronic cough
- diagnosis
- by direct visualization using an otoscope (2)
- management
- consider ear irrigation using an electronic irrigator, microsuction
or another method of earwax removal (such as manual removal using a probe)
for adults in primary or community ear care services if:
- the practitioner (such as a community nurse or audiologist):
- has training and expertise in using the method to remove earwax
- is aware of any contraindications to the method
- the correct equipment is available
- when carrying out ear irrigation in adults (1):
- use pre-treatment wax softeners, either immediately before
ear irrigation or for up to 5 days beforehand
- if irrigation is unsuccessful:
- repeat use of wax softeners or
- instil water into the ear canal 15 minutes before repeating
ear irrigation
- if irrigation is unsuccessful after the second attempt,
refer the person to a specialist ear care service or an ear, nose
and throat service for removal of earwax.
- possible complications of wax removal are:
- pain,otitis externa,perforation of tympanic membrane, tinnitus,dizziness,syncope,cough,
cardiac arrest (2)
- golden advice to patients
- "Never put cotton swabs or other objects into the ear canal"
(3)
Reference:
Last edited 09/2018
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