Impacted wax is one of the commonest ear problem among the healthy community. The functions of wax ( known as cerumen) is to protect the ear canal skin and also help in lubricating the ear canal. At some extent, the ear wax actually helping to protect the ear canal from infection.
There are two distinctive type of ear wax which are wet type and dry type. In Asia, dominantly the ear wax is dry in nature, meanwhile among the european and african populations, wet wax is dominant. In dry type the wax is usually gray, dry and flaky in nature ,meanwhile in wet type, the wax is usually moist and dark brownish in colour.
In normal situation, the ear wax would be cleaned up by the epithelial migration and aided by jaw movement. In cerumen, there is sebum which is secreted by sebaceous glands would help in lubricating the ear canal.
Regular Ear wax removal especially in children by their parents are not encouraged. The common mistake among a lot of parents would be trying clean up their kids ear regularly with cotton bud. Using cotton bud in cleaning up the ears is not effective in removing the wax properly, furthermore the cleaning with cotton bud will push the wax deeper in the ear canal and over a period of months to years, impaction of wax would happened.
Ear pick should not be used in picking up the wax in children as there are a lot of incidents where ear canal and even the ear drum were injured or perforated during the session of ear picking.
Impacted wax would give much of distress to patient as it causes ear discomfort and even pain especially when the wax is wet. Reduced hearing and ear blockage are among the symptoms of impacted wax. Hearing aid functions might be impaired by impacted wax.
When the wax is still minimal and not impacted, wax softeners could be helpful in removing the wax. Urea hydrogen peroxide (6.5%) and glycerine , sodium bicarbonate in water and cerumol are among the cerumenolytic agents that could be used to softened the wax.
When the wax is impacted or moderate in amount, medical help should be seek to clear off the wax from the ear canals. There are a few method in removing the wax, simplest way which could be done by general practitioner would be ear irrigation or syringing with warmed body temperature normal saline or water. Nozzle should be directed to supero-medial beyond the wax and water will bounce back by the tympanic membrane. Perforated tympanic membrane is relative contraindication in ear irrigations. The complication of ear irrigation would be ear drum perforation and otitis external especially when the water is not properly dried up after the irrigation. Patient might experience dizziness or spinning sensation during the procedure especially when the water temperature is not according to body temperature.