The skin on the cartilage of the external auditory canal has ceruminous glands that produce cerumen. When there is excessive secretion of cerumen or obstruction of cerumen migration, the accumulated cerumen obstructs the external auditory canal, which is termed cerumen impaction.
Clinical manifestations
Hearing loss, tinnitus, otalgia, and even dizziness may occur. Reflex cough may also be caused by stimulation of the auricular branch of the vagus nerve in the external auditory canal. After contact with water, cerumen expands and completely blocks the external auditory canal, which may cause sudden drop in hearing. Repeated stimulation of the external auditory canal by cerumen can cause external otitis. Examination shows that dark brown or yellowish brown cerumen blocks the external auditory canal. Cerumen can be hard and soft.
Figure 1 Cerumen impaction
Treatment
Extraction of cerumen should be careful to avoid damaging the external auditory canal and tympanic membrane.
For cerumen that is movable and does not completely block the external auditory canal, angular forceps or cerumen hook can be used. Soft cerumen can be separated from the external auditory canal wall and removed. For hard cerumen, a cerumen hook is used to separate the cerumen from the wall of the external auditory canal through the posterior superior wall of the external auditory canal, the cerumen hook is inserted into the cerumen, and the cerumen can be extracted smoothly and completely.
For dry and hard cerumen that is difficult to remove, 5% sodium bicarbonate solution is dripped 4 - 6 times a day, once the cerumen is softened, the external auditory canal can be rinsed with saline, and the cerumen is removed. In patients with external otitis, antibiotics should be given to control inflammation.
For deep cerumen that is difficult to remove or in patients with poor coordination, the cerumen can be removed with the assistance of otoscope after the cerumen is fully softened.