Earwax

Earwax contains sebaceous material and the products of the ceruminous glands which line the outer one-third of the ear canal. These secretions combine with desquamated skin and hair to form wax, about which many patients develop an obsession. Wax varies in color and consistency, and its production appears to be partly controlled by circulating catecholamines. It is normal to have some cerumen in the ear canal. Wax provides protection to the skin and also possesses bactericidal activity. Ear canal epithelium migrates outwards, providing a natural cleaning mechanism for desquamated tissue and cerumen. Attempts to clean the ear by a patient invariably force the ear canal contents deeper into the meatus. Wax impaction therefore is a common cause of hearing loss. If water enters the ear, the desquamated keratin expands, often trapping fluid in the deep meatus. This may cause an otitis externa unless the plug is removes.

Earwax can be secreted in one of two forms. Wet wax is produced by most people of African origin and is familiar as moist, sticky and honey colored. The dry type is more common in Mongoloid ethnic groups and tends to be greyer in color, less sticky, granular and brittle. The gene for wet wax is dominant. Regardless of type, earwax tends to become drier with age as a result of reduced glandular numbers and activity. Wax is then normally loosened by transmission of movement from the temporomandibular joint from chewing or talking, allowing its passage out of the external auditory meatus. This natural process can be upset by a number of factors and cause earwax impaction.

How Earwax is Formed?:

Earwax, is formed on the concave side of the base of the auricle and in the external ear canal. It is a mixture of the secretions of the sebaceous and ceruminous glands. It has a waxy consistency and varies in color from yellow to brown. The secretion of the sebaceous glands being gray to white and that of the ceruminous glands being brown, the color of earwax varies with the relative contribution of each. A thin layer of earwax is normally present in the areas where the glands are located and sometimes small lumps are found at the base of the auricle at the entrance to the ear canal. The odor of earwax is usually described as aromatic, but if the skin of the base of the auricle and the ear canal is inflamed, the production of earwax can be increased and its composition can be changed. An increase and alteration in the bacterial flora can change the appearance of the earwax and give it a more penetrating odor. When combined with pus and detritus, its appearance and odor may become overwhelming and repulsive.

Primary inflammatory disease of the middle ear mainly causes pain. It is usually unilateral and appears to be severe. The animal shuns petting of its head and loses alertness and appetite. Hearing loss is to be expected but is almost never mentioned by the owner. If the inflammation is ruptured, there can be purulent discharge from the external ear canal.

Problems with Excess Earwax:

Excessive buildup of earwax also can cause problems. Some signs and symptoms of ear include:

• Dizziness
• Loss of hearing
• Nausea and vomiting
• Earache
• Bleeding or discharge from the ear
• Swelling or redness
• An object visible in the ear

Removal of Earwax:

Meatal occlusion, impaction, irritation, hearing loss or otitis externa and clinical inspection of the eardrum are all indications for removing wax. The simplest method is to syringe the ear. Tap water at body temperature is used. The pinna is lifted to straighten the ear canal and the water jet aimed at the roof of the canal, never directly at the eardrum. The canal and drum head must be examined afterwards. Patients who have perforations should not have their ears syringed. Curetting wax from the canal requires a good light and a cerumen scoop or hoop. In difficult or refractory cases a microscope and sucker may be used in outpatients, or under general anesthesia. Hard impacted wax may need to be softened with topical ceruminolytic ear drops prior to removal.