Ear Irrigation

Excerpt

Cerumen, commonly known as earwax, is a naturally occurring substance produced in the outer portion of the external auditory canal (EAC). The EAC contains pilosebaceous glands, ceruminous glands, hair follicles, and sebaceous glands. Modified sweat secreted by ceruminous glands exhibits bactericidal and fungicidal properties and contributes to lubrication and self-cleaning of the EAC. As dead skin cells are shed and migrate out of the canal, they combine with sebaceous secretions and ceruminous sweat to form cerumen, which consists primarily of dead keratinocytes. Cerumen functions as a protective barrier that traps foreign particles. Pathologies of the EAC include sebaceous cysts, furuncles, and glandular tumors, although cerumen accumulation and impaction remain the most common clinical concern.

The American Academy of Otolaryngology defines cerumen impaction as "an accumulation of cerumen associated with symptoms, preventing the necessary assessment of the ear, or both." Although cerumen is typically expelled from the EAC spontaneously with jaw movement, this mechanism may fail in some patients, leading to impaction. The condition occurs more frequently when normal cerumen extrusion is impeded by hearing aids, persistent use of earplugs or earbuds, or attempts to clean the ears with cotton-tipped applicators. Common symptoms include ear fullness, otalgia, pruritus, dizziness, cough, and decreased hearing. Prevalence estimates indicate that approximately 5% of healthy adults, 10% of children, 57% of older adults, and 33% of patients with intellectual disability experience cerumen impaction.

Irrigation of the EAC is one of several treatment options for cerumen impaction and is readily available in general practice and emergency departments. Nonclinicians may perform irrigation, which carries both advantages and potential disadvantages. Ear irrigation may be performed alone or after pretreatment with a cerumenolytic agent, such as acetic acid, mineral oil, or hydrogen peroxide. A comprehensive history and physical examination, including otoscopy, is essential to confirm an intact tympanic membrane, verify the absence of tympanostomy tubes, and identify anatomical abnormalities, including squamous debris or retraction pockets suggestive of cholesteatoma or prior ear surgery, before attempting irrigation. Referral to an otolaryngologist is recommended if contraindications are present or irrigation fails to remove the cerumen.