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Ear Wax
Lawrence Pike
• Ear Wax (Cerumen) is a natural protective
oily substance which is produced in the
outer third of the ear canal
• Its function is to remove small foreign
particles, such as dust, from the canal
• This is achieved by the ciliary hairs.
• Diminished hearing
– often of sudden onset after “cleaning” the
• Discomfort
– seldom complain of pain unless the wax is
pressing on the drum
• Tinnitus occasionally
Educational Points
 Wax is a normal physiological substance which
has an important role in protecting the ear canal
 The ear canal is a self-cleaning system, do not
to use cotton buds as wax is more likely to be
pushed back against the eardrum and become
 Ear wax only needs to be removed if it causes
symptoms or if a proper view of the eardrum is
Self Care
• Assess if:
– Child
– Pain
– Discharge from the ear
– Known perforation of the eardrum
– Previous mastoid surgery
Self Care
 Ear drops to soften ear wax (ceruminolytics) may be
used as the only treatment in mild cases.
 There are many different preparations on the market,
none with any clear clinical advantage compared to the
 There is some suggestion that sodium bicarbonate may
be particularly effective at disintegrating ear wax.
 A simple home remedy is olive oil, warmed by pouring
onto a warm spoon.
 Preparations containing organic solvents are particularly
likely to cause irritation and inflammation of the external
ear canal and should be avoided.
Primary Care Treatment
• In more severe cases use of a
ceruminolytic ear drop for 4 to 5 days
prior to syringing is advisable
• Removal with wax hook is also an option
Ear Syringing
• Ear syringing has been shown to improve
hearing in those with impacted wax
The lowest pressure possible should be used.
It is best avoided if
– the eardrum is known or suspected to be perforated
– there is a history of mastoid surgery or chronic middle
ear disease
– If patient has unilateral deafness
– A history of recurrent otitis externa or tinnitus
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