Cerumen

This is also known as ear wax. This is a yellowish waxy substance secreted in the external auditory canal of humans. It protects the skin lining of the external auditory canal from excessive moisture. It also protects the external canal from bacteria, fungi and insects.

Humans are known to secrete two types of cerumen:

1. Soft and moist

2. Firm and dryPersons secreting soft and moist type of ear wax have no problem due to its accumulation. It can easily be extruded by the normal cleansing mechanism of the external auditory canal. This difference in wax secretion has been traced to alterations in C11 gene. Persons secreting frim and dry wax are more prone for impaction of cerumen.

Impaction of cerumen causes conductive hearing loss.Cerumen is usually produced in the outer third of the cartilagenous portion of the external auditory canal.

It is composed of:

1. Viscous secretions from sebaceous glands

2. Less viscous secretions from modified apocrine sweat glands

3. Shed layers of skinCerumen has been found to have bacterostatic effect.

Excessive occlusion of the external canal due to accumulation of cerumen and desquamated epithelial cells associated with migration defect of the lining epithelium can cause keratosis obturans. This is a painful condition which needs to be treated by removing the mass under anesthesia.Removal of cerumen can be performed using probes / curettes if the consistency is soft. If cerumen is excessively soft then cotton buds can be used for removal.Firm cerumen should be lubricated by using ceruminolytics / liquid paraffin to soften it up before attempted removal.Aural syringing is one of the painless way of removing accumulated cerumen.