Excessive sulfur secretion, changes in its consistency, and anatomical features of the auditory canal may predispose to the formation of sulfuric plug in a child.
Increased formation of earwax can provoke foreign bodies of the ear, otitis in children, water entering the ears, eczema, dermatitis, hearing aid wearing, frequent use of headphones. A special role in the hypersecretion of the ear glands and the formation of a sulfuric plug belongs to overly zealous attempts to clean the child’s ears with the help of cotton buds. This leads to irritation of the sulfur glands, an increase in the production of sulfur, as well as pushing, tamping and fixing an existing secret in the bone region of the auditory canal.
In addition to the increased risk of sulfur plug formation, this “hygiene” is fraught with injury to the ear canal and damage to the eardrum, which in 70% of cases in children are caused by improper use of cotton swabs.
The accumulation of sulfur can contribute to the anatomical narrowness and tortuosity of the external auditory canal, which may be hereditary in a child, as well as the problem of sulfur plugs. Recurrent formation of dry sulfur plugs in a child may be due to insufficient humidity in the children’s room.
Types of sulfuric cork in a child
Depending on the consistency of the secret, children have the following types of sulfur plugs:
- paste-like – have a light or dark yellow color, soft texture;
- plasticine – have a brown color and a viscous (plasticine) texture;
- solid (dry) – color varies from dark brown to almost black; tough consistency.
Soft and loose at the beginning, over time, a sulfur plug in a child may acquire a dense and even stony texture. An independent phenomenon is the epidermal (epidermoid) plug formed mainly by desquamated scales of the stratum corneum of the epidermis. It has a stony density, whitish or gray; tightly adjacent to the walls of the ear canal, which can lead to the formation of pressure sores in the bone region.
Sulfur masses in a child can fill a part of the external auditory canal (parietal sulfuric plug) or occupy the entire auditory canal entirely (obturating sulfuric plug).
Symptoms of sulfuric plug in a child
Sulfur plug in a child can be asymptomatic for a long time until it blocks the ear canal by more than 70%. Usually, swelling of sulfur and complete obturation of the external auditory canal with sulfuric masses is preceded by water ingress into the ear when bathing a child. In this case, congestion and noise (hum, ringing), pain in the ear; sometimes the sensation of itching of the external auditory canal, autophony (enhanced resonance of his own voice).
A characteristic sign of sulfuric cork is hearing loss, which may not be felt by the child himself, but may be noticed by some signs (the child does not respond to the call, often asks again, shudders when strangers appear in the room, etc.). Signs of sulfuric cork in an infant can be anxiety, constant attempts to touch, scratch, rub the ear.
When placing a sulfuric plug in the bone section and pressure on the eardrum, reflex symptoms may occur, including cough, nausea, dizziness, headache; rarely, cardiac disorders and facial nerve paralysis.
Diagnosis of sulfuric plug in a child
Sulfur cap in a child can be detected by a pediatrician by visual inspection of the outer ear. However, in order to accurately identify the causes and associated diseases, as well as to treat the crayfish tube, the child needs the advice of a pediatric ENT specialist.
When otoscopy is performed on a child, the sulfur plug is visible as a brownish or black mass that shields the eardrum. When examining with the help of a bell-shaped probe, the consistency of a sulfur plug in a child is determined. During audiometry, a characteristic hearing loss is detected.
Sulfuric cork in a child must be differentiated from the foreign body of the ear canal, sensorineural hearing loss, otomycosis, cholesteatoma, germinated in the external auditory canal.
Treatment of sulfuric plug in a child
Attempts to self-extract the sulfuric plug in a child with the help of tweezers, pins, cotton swabs are unacceptable. The decision on the method of removal of the cork is made by the specialist based on the results of the endoscopic examination.
Most often in children, the removal of sulfuric plug is performed by washing the external auditory canal. For this procedure, furatsilina solution or a weak solution of potassium permanganate is used, heated to body temperature (to avoid reaction of the vestibular apparatus), Janet’s syringe or 20 ml disposable syringe without a needle. During the washing procedure, it is important to fix the child well, in order to exclude possible damage to the external auditory canal. Using a syringe, the doctor under pressure delivers a jet of fluid into the child’s auditory canal cavity, which washes away the sulfur tube.
If a sulfuric plug in a child has a dense consistency, it is pre-softened for 2-3 days by instillation of 3% of hydrogen peroxide into the external auditory canal. According to the appointment of a pediatrician, cerumenolysis can be recommended (dissolution of the sulfuric plug in a child) with the help of special preparations (A-Cerumen, Remo-Vaks).
If the child has a history of perforation of the eardrum, otitis externa, or persistent hearing loss, an instrumental removal of the sulfur tube is performed using tweezers or a probe hook under visual control (curettage). A soft sulfuric plug can be aspirated from the external auditory canal using an electric suction unit.
After removal of the sulfuric plug in a child by any method using otoscopy, you must ensure that it is completely removed, dry the ear canal and close it with a cotton swab for several hours.
Prevention of sulfur plugs in a child
After the removal of the sulfuric plug, the child, as a rule, immediately hears up and unpleasant subjective sensations disappear. Some children have re-formation of sulfur plugs. Sulfuric tube removal by washing is extremely rare (1: 1000 cases) may be complicated by nausea, vomiting, bleeding, rupture of the membrane.
If a child has an increased tendency to form sulfur plugs, it is necessary to visit an otolaryngologist at least once every 6 months. It is strictly forbidden to use cotton swabs, as well as other traumatic items for cleaning the auditory passages; to extract excess sulfur from the auditory canal, it is recommended to use flagella from sterile cotton wool.
Since sulfur plug is not uncommon even in infants, the pediatrician needs to carry out a preventive examination of the outer ear in children of this age category.
Sulfur plug in a child is a blockage of the external auditory canal with a secret of the ceruminous glands located in the skin. Sulfur plug in a child is manifested by noise and ear congestion, hearing loss, autophony; when the cork is located in the bone region – reflex cough, headache, dizziness, nausea. Sulfur plug in a child is diagnosed by a pediatric otolaryngologist in the process of otoscopy. Removal of the sulfur plug in a child is carried out by washing it out with a syringe (after preliminary softening of the secretion or without it) or instrumentally, using an ear hook or tweezers.
Sulfur plug in a child – partial or complete obturation of the external auditory canal with an accumulation of its own secretion (earwax) and desquamated epidermis. The problem of sulfur plugs is quite common in adult and pediatric otolaryngology. Sulfur plug is diagnosed annually in 4% of the population, including children. Sulfur plug can form even in an infant, and 20% of infants need to be removed by a pediatric otolaryngologist.
Earwax is a secretion of ceruminous (sulfuric) glands located in the skin of the membranous-cartilaginous part of the external auditory canal, mixed with the secretion of the sebaceous glands and desquamated epithelium. The main biochemical components of sulfur are lipids, cholesterol and unsaturated fatty acids. Antifungal and antibacterial activity is provided by acidic reaction (pH-4-6), enzymes, fatty acids, lysozyme and immunoglobulins. The main function of earwax is to naturally cleanse the ear canal from dead cells, dust particles; protection from various exogenous biological and physical-chemical influences; moisturizing and preventing the epithelium of the ear canal and tympanic membrane from drying out.
Normally, earwax removal occurs spontaneously, thanks to the movements of the temporomandibular joints when chewing, swallowing, talking. However, under certain conditions, the purification of the external auditory canal in a child becomes difficult, and the accumulated secret is transformed into a so-called sulfur tube.