The effects of education cerumen tangible, if she is fully or almost fully covers the ear canal. When this occurs hearing loss (hearing impairment), which refers to a conductive type of hearing loss – that is, arising from violations of the structures involved in the conduction of sound to the sound the ear hearing.
Cerumen impaction is the accumulation of earwax, obstructing the lumen of the external auditory canal. First, it is formed as a soft elastic mass, and then acquires a firmer texture.
By itself, the blockage is not critical phenomenon with dire consequences to the ear, but often patients are careless cleansing of the external auditory canal, which can develop infectious complications.
Cerumen in fact, does not consist of sulfur as a chemical element of the periodic table. Earwax is a mixture of secretions (secretions) glands, which are located deep in the skin lining the external auditory meatus. Sulfur glands are located deep in the ear canal, they are clean, with nothing mixed secret milk like substance and has a slightly creamy hue.
In addition to sulfur, in the external auditory canal are:
- superficial sebaceous glands, which produce the so-called sebum;
- apocrine sweat glands, which produce sweat.
The allocation of these glands is mixed with a secret of sulfuric glands and with dead skin particles of skin epithelium that covers the external auditory meatus. End result, formed a distinctive yellowish discharge that millions of people around the globe every day throughout life patiently extracted from the ear canal.
Normal earwax serves as a protection – it prevents such negative changes of the external auditory canal as it is:
- dryness of the skin;
- maceration – wet corrosion of tissues;
- lose pathogenic bacteria and fungi and viruses that can lead to the development of external otitis. Is prevented by the fact that earwax is acidic environment;
- blockage of the external auditory canal with dirt, dust particles, small third-party items. Such clogging is prevented as follows: during chewing, talking or yawning moves in the mandibular joint, located close to the outer auditory passage, due to the movement of ear wax out along with small particles.
If there is wax build-up, then she comes crashing in the described protective mechanisms.
Causes and development of disease
The formation of cerumen is due to such main causes as:
- excessive formation of earwax;
- changing its composition;
- the deterioration of the breed;
- improper sanitary and hygienic measures to clean up the external auditory canal.
Excess ear wax is extracted with the help of basic sanitary fixtures, but due to the different employment of the person is not able to do it so often, in order to clear the ear canal from sulfur clusters. Therefore, due to the increased secretory activity of cerumen sulfur glands rather quickly accumulates in the external auditory canal, forming a sulfuric stopper.
Increased production of earwax is observed in such diseases and conditions as:
- dermatitis – inflammation of all layers of the skin of the ear canal, which occurs when subjected to chemical, mechanical, thermal and other factors;
- eczema – inflammation of the superficial skin layers of the auditory canal with swelling, itching and formation of papules (bumps);
- chronic otitis externa – inflammation of the structures of the outer ear (including cartilage);
- frequent and improper ear cleaning. It stimulates the strengthening of the activities of ear glands and greater production of earwax;
- increase the blood amount of cholesterol is one of lipids (fats) produced in the body.
In some families, seen a predisposition to excessive formation of earwax. But the tendency of relatives is not necessarily hereditary, deterministic (predefined) is equally increased secretion of ear wax these people may be explained by their living in the same conditions.
Changes in the composition of earwax may occur as a consequence:
- endocrine failure;
- the metabolic disorders;
- lesions (often inflammatory) in the ear glands of different Genesis (origin);
- dehydration of the body due to infection, vomiting, bleeding, burns and some other pathogenic factors.
Violation of evacuation of (elimination) of earwax from the external auditory canal is associated with the mechanical factor – the formation of any obstacles.
Most often, such things as cause such diseases and pathological conditions such as:
- anatomical narrow external auditory canal;
- his innate tortuosity;
- contraction due to changes in the soft tissues – in particular, because of their edema, the developing inflammatory process;
- obstruction (obstruction) of the external auditory canal foreign body partial or full;
- increased growth of hair in the external ear canal is often observed in elderly patients (often males), though it may also occur as a manifestation of General enhanced growth of hair on all parts of the body;
- wearing a hearing aid;
- frequent use of headphones and/or earplugs (tools for intentional overlapping of the lumen of the external auditory canal to restrict the flow of sounds in the ear);
- features of labor and other employment.
Cerumen is often formed of persons employed in manufacturing with high dustiness. This:
- employees of tobacco shops
and so on.
Also, cerumen impaction often occurs in people who are in employment spend a lot of time in the water – even a small amount of sulfur is able to swell to such an extent that it forms sulfuric tube.
Such a mechanism of its formation is observed in:
- divers (divers);
- athletes playing water Polo;
- employees Dolphinarium
and so on.
The mechanism of formation of cerumen when properly conducted activities aimed at the hygiene of the outer ear, the following.
Between the outer membranous and cartilaginous part of the auditory canal and deeper bone fragment, there is a narrow isthmus. Earwax is produced exclusively in the membranous-cartilaginous Department, but it can get into the bone fragment auditory meatus improper ear cleaning. Removal of earwax back across the isthmus is difficult, as a result, there is cerumen. It mostly happens with regular push earwax over the isthmus to the eardrum. At this place the sulphur is compressed due to a too deep immersion in the external auditory meatus ear stick or other object that is used during the cleaning of the ears.
Its consistency cerumen is:
Often, the blockage occurs in one ear. It is indicative of the fact that when you remove the sulfur concentrations in the patient may re-experience the formation of cerumen. If after regular removal of the tube, observance of sanitary and hygienic rules and preventive measures (they will be discussed below) earwax still delayed, should be suspected any systemic pathology in the first place to hold a screening for endocrine abnormalities, diseases of metabolism and so on.
Cerumen impaction: symptoms
If the ear wax is not fully removed from the ear, it gradually accumulates, while the sulphur mass, losing moisture, becomes more dense and solid. The patient such transformations do not feel – he feels the change in the ear only when the cerumen covers the external auditory meatus.
This can happen not only with its increase in size, but when you turn the tube and/or displacement, which entails a reduction of the lumen of the external auditory canal at the location of the cerumen.
Symptoms often develops suddenly. Often, this happens:
- in case of unsuccessful carrying out of patient hygiene procedures;
- after a short time after the ingress of liquid into the ear canal.
If there is a contact sulfuric tube with water, it rapidly swells like a sponge. The condition is compounded by the fact that the soft tissue can react to the presence of water and most cerumen – this reaction is manifested by signs of inflammation and the rolling, in particular, edema of the soft tissues.
The typical signs of obstruction (blockage) of the external auditory canal is:
- feeling of stuffiness;
- the noise in the ear;
- hearing loss (hearing impairment);
- autophone – the echo of your voice in the ear of the patient.
When the feeling of stuffiness, the patient seems that the sounds received in the ear, “breaking” through the tissue layer.
The noise in the ear when sulphuric tube most often resembles the sound of the surf or selestina fallen leaves.
Hearing loss when sulphuric tube develops suddenly – this nuance is a useful aid in the differential diagnosis.
Joins pain syndrome – but it is not due to cerumen, and for the reason that the patient wanting to restore hearing in full, picks his ear canal with sharp objects to hurt it with a soft cloth. If too intense picking in the ear can cause bleeding.
If cerumen formed near the eardrum, it is increasing pressure on it raises the following symptoms, which resembles the symptoms of vestibular disorders:
- nausea and, in particularly sensitive patients – vomiting that does not bring relief;
- cough – he has a reflex nature. Sick often, over and over again, and coughs;
- dizziness that is not associated with turns of the head or change of body position in space.
If cerumen for a long time puts pressure on the eardrum can occur:
- miringa – inflammatory lesion of the eardrum;
- otitis media – inflammation of middle ear structures.
Both conditions are manifested by pain syndrome.
In most cases, the diagnosis of cerumen supply is not difficult. Some difficulties arise when symptoms are fuzzy (for example, there is no echo of your voice, the pathological condition), and the tube is deep, and its detection requires special inspection.
As cerumen is manifested by the features that are characteristic of several pathological conditions of the ear, it is necessary even if you have minimal symptoms a comprehensive ENT examination, to not miss a more complex pathology. For this purpose the collecting of anamnesis (history of disease) and results of additional methods of research.
The physical examination the following:
- during the inspection – because of hearing loss the patient during the conversation with the doctor subconsciously turns his head to hear his neskondensirovannyh ear. Often patients are even on the doctor’s make subconscious attempts to clean the finger ear canal. Because of the unpleasant sound sensations small children can constantly drag on a handle to your ear from the affected side.
In the diagnosis of cerumen and its possible complications apply such instrumental methods as:
- otoscopy – inspection of the external auditory canal with ear mirrors, the reflector and the bellied probe. On examination revealed a yellowish amorphous mass or rounded education, clogging the ear canal. Bellied probe to determine which has the consistency of cerumen (it is important to choose the method to retrieve it);
- microeconomia – the study of external auditory canal with the aid of the clinical microscope. The goals are the same as when performing otoscopy, but longer – microscope helps to identify even the most inconspicuous violations of the skin of the external auditory canal, which can occur when the patient attempts to extract sulfuric plug.
During these research methods should pay attention not only on the characteristics of cerumen, but also on the condition:
- the skin lining the external auditory meatus;
- of the eardrum. An important exception is the perforated hole in it, which could occur after the previous acute or chronic suppurative otitis media. The status of the tympanic membrane is crucial to select a method to extract the cerumen.
Differential diagnosis of
Differential (distinctive) diagnosis of cerumen are often carried out with such diseases and pathological conditions of the ear, such as:
- epidermal cork – formation, which formed from the desquamation of skin cells lining the ear canal;
- foreign body a foreign object in the lumen of the auditory canal;
- ear tumors – non – malignant and malignant (including metastatic – formed by the migration of groups of cells from primary tumors, which can appear in any organs and tissues);
- cholesteatoma is the formation of tumors, which consists of a capsule surrounding a cavity filled with dead epithelial cells and some organic substances (keratin, slepushkina in a single conglomerate crystals of cholesterol).
Complications that may accompany sulfur tube is:
- conductive hearing loss – hearing loss;
- the bleeding is too severe activity of the patient, aimed at self-removal of cerumen;
- infectious-inflammatory complications.
The latter include a number of pathologies that results in independent patient attempts to clean the ear canal that resulted in the violation of the integrity of the skin, infection and dissemination of pathogenic organisms to other organs and tissues.
This is mainly long-term complications that require time to develop. These include:
- miringa – inflammation of the eardrum;
- otitis media – inflammation of middle ear structures;
- atomikos – fungal inflammation of the ear structures;
- labyrinthitis – inflammation of the labyrinth of the inner ear.
When the extreme carelessness of the patients to their health and severe neglect of the state may be long-term complications, such as:
- meningitis – inflammation of the meninges;
- encephalitis – inflammation of brain tissue;
- thrombophlebitis of the cavernous sinus simultaneous inflammation and blockage by a thrombus (a blood clot) splitting of the Dura mater, which plays the role of storage of venous blood;
- sepsis – the spread of the infectious agent from the primary tumor throughout the body.
Removal of cerumen in the ear
Cerumen removal must be conducted by a specialist in the clinic. Self-destruction of the materials at hand is prohibited.
There are several methods for removal of cerumen. Their choice depends on the data obtained by otoscopy.
Often sulfuric stopper is removed by flushing the ear. The procedure is technically simple: in the external auditory canal with a syringe Janet (or syringe with maximum volume) is introduced in the liquid. It can be:
- solution furatsilina;
- sterile saline;
- boiled water.
The liquid should be heated to a temperature of 37 degrees Celsius. This allows you to avoid stimulation of receptors in the skin of the external auditory canal and reflex reactions of dizziness, nausea, vomiting, headache.
The liquid is introduced into the ear under pressure is boosted, while controlling for the patient have not any pain. The procedure was repeated until the washings do not appear typical of cast selections. If after its removal the patient continues to complain of stuffiness in the ear, it may be due to the fact that he was removed only a fragment of the tube, and the procedure must be repeated.
Pastopodobny and plastilinovaya cerumen may be removed by washing immediately after its detection. To remove the rigid tube it must first be softening. The softening procedure was carried out for 2-4 days before washing. To do this, use 3% hydrogen peroxide solution, which is heated to a temperature of 37 degrees Celsius. Solution instilled into affected ear 3 times a day. The patient should be warned that it can further deteriorate the hearing and increase the feeling of stuffiness is associated with swelling of the cerumen.
Removal of the tube by leaching is contraindicated if the integrity of the eardrum, the fluid can get into the middle ear cavity and cause the development in it of the inflammatory process.
In these patients the procedure of the extraction tube is carried out by so-called dry tool removal – by:
- ear hook;
- ear forceps;
After removal of ear cerumen in the external auditory canal with the purpose of prevention of infection for 2-3 hours administered turundas with boric alcohol.
The basis of prevention of occurrence of cerumen on the following activities:
- prevention of lesions of the external auditory canal, provoking increased production of earwax, namely, dermatitis, eczema, chronic external otitis. If they have already developed, it is necessary to timely diagnosis and adequate treatment;
- proper cleansing of the ears;
- prevention and proper treatment extranasal (Vansovich) pathologies that can provoke an increased production of earwax endocrine failure, metabolic disorders, lesions of the auricular glands;
- the prevention of dehydration;
- people with high hairiness in the external auditory canal is the timely removal (cutting) of the hairs;
- the correct selection of hearing aid;
- avoiding frequent use of headphones and earplugs;
- avoidance of employment in areas which involve working in dusty atmosphere;
- preventive examinations at an otolaryngologist even if there are no complaints.
Despite the fact that cleaning of the external auditory canal sulfur is a fairly simple procedure, it should be carried out according to certain rules:
- earwax is removed only from the surface of the ear and the area around the opening of the auditory passage;
- in case of accumulation of ear wax in other places, its removal should pursue a medical specialist.
The prognosis of sulphuric tube favorable. Any complications occur rarely, but there are cases of complications (particularly intracranial), which require intensive therapy.