Ear Wax / Cerumen
The ear canal is approximately 2.5 cm long in the adult and is divided into an external 1/3 and an inner 2/3. In the outer 1/3 there are ceruminous and sebaceous glands that secrete into the ear canal minute quantities of cerumen and sebum that combine with the slowly shedding skin of the external auditory canal. Skin of the external canal has a natural tendency to migrate laterally and mix with the cerumen and sebum to create wax in the outer 1/3 of the external auditory canal. It is for this reason that if wax is visualized deep in the external canal that this is often a sign that it has been pushed here.
Wax is a natural protector of the external canal and has some bactericidal properties as well as water protective functions. Unfortunately sometimes patients produce excessive amounts of wax that can cause problems.
Patients often feel a blocked sensation secondary to wax impaction and a decrease in their level of hearing. Occasionally wax produces a degree of discomfort and if irritated can produce a degree of otitis externa.
Wax naturally discharges itself from the ear canal and more often than not it is the incessant fiddling that is commonplace amongst humans that causes irritation and pushes wax deeper into the ear canal. We can help this by not putting any objects such as cotton buds into the ears and also by softening the wax with the use of olive oil drops.
If wax becomes a problem then this can be treated by removal under direct vision with a headlight and specialist instrumentation.
Alternatively ear irrigation can be undertaken by a trained practitioner but it is essential that the ear is dryed after this procedure and that it is undertaken by a person trained specifically in this.
The use of a microscope can be very useful in removing wax as this gives the operator binocular magnified vision whilst having hands free to use instruments and suction to remove wax