Earwax क्या है और क्यों बनता है?

Cerumen (Earwax) की Anatomy और Physiology

Production Site:

Earwax external auditory canal के outer 1/3 part में बनता है, जहां specialized glands होती हैं:

• Ceruminous Glands: Modified apocrine sweat glands जो oily secretion produce करती हैं
• Sebaceous Glands: Fatty sebum produce करती हैं

इन दोनों secretions का mixture + dead skin cells = Earwax

Composition of Earwax:

• Lipids (fats): 60%
• Dead skin cells: 30%
• Proteins: 7%
• Other substances: 3%

Types Based on Genetics:

1. Wet Type (Sticky, Brown):

• Dominant gene
• Common in Europeans, Africans
• More lipid content
• Sticky consistency

2. Dry Type (Flaky, Gray):

• Recessive gene
• Common in East Asians (80-95%)
• Less lipid, more protein
• Dry, flaky consistency

Color Variations (Normal):

• Yellow/Light Brown: Fresh, new wax
• Dark Brown/Black: Old, oxidized wax
• Orange: Old wax with debris
• White Flaky: Dry type

⚠️ Abnormal Colors:

• Red/Blood-tinged: Trauma, injury – needs examination
• Green: Infection present
• Very Foul Smell: Infection या foreign body

Natural Functions of Earwax – Why It’s Important

1. Protection from Infections

• Antibacterial Properties: Contains lysozyme enzyme जो bacteria को kill करता है
• Antifungal: Acidic pH (4.0-5.0) fungal growth को prevent करता है
• Physical Barrier: Bacteria, viruses को eardrum तक जाने से रोकता है

2. Lubrication

• Ear canal skin को dry होने से बचाता है
• Prevents itching और irritation
• Skin flexibility maintain करता है

3. Trapping Mechanism

• Dust & Dirt: Tiny particles trap हो जाते हैं
• Dead Skin Cells: Canal से naturally shed होने वाली cells
• Insects: Small insects को inside जाने से रोकता है
• Water Repellent: Water को eardrum तक जाने से रोकता है

4. Self-Cleaning Mechanism

Normal ear canal में “conveyor belt” mechanism होता है:

1. Wax deep canal में produce होता है
2. Jaw movements (chewing, talking) से canal skin migrate करती है outward
3. Wax along with trapped debris बाहर की ओर move करता है
4. Ear opening पर पहुंचकर naturally बाहर गिर जाता है या bathing में wash हो जाता है

यह process लगभग 2-3 weeks लेता है। इसलिए normally कान cleaning की जरूरत नहीं होती!

Earwax Impaction – कब Problem बनता है?

Definition:

Earwax impaction तब होता है जब wax ear canal को partially या completely block कर देता है और symptoms produce करता है।

Prevalence:

• General population: 10% adults, 5% children
• Elderly (>65 years): 30-35%
• Hearing aid users: 60-70%
• Mentally/physically challenged: Higher incidence

Causes of Impaction:

1. Cotton Bud (Q-tip) Use – सबसे Common Cause

यह सबसे बड़ी और common mistake है:

• Pushes Wax Deeper: Instead of cleaning, cotton bud wax को और अंदर push कर देता है
• Compaction: Wax compact और hard हो जाता है
• Stimulates More Production: Irritation से और wax बनता है
• Injury Risk: Drum perforation, canal abrasion possible
• Infection Risk: Bacteria को अंदर push करना

⚠️ GOLDEN RULE: “Nothing smaller than your elbow should go in your ear!”

2. Narrow or Abnormal Canal Anatomy

• Congenitally narrow canals
• Bony exostoses (surfer’s ear – cold water exposure)
• Osteomas (benign bone growths)
• Post-surgical stenosis

3. Excessive Wax Production

• Genetic factors
• Hormonal changes
• Skin conditions: Eczema, psoriasis
• Stress (increases sebaceous gland activity)

4. Hearing Aid Use

• Physical blockage of self-cleaning pathway
• Pushes wax deeper
• Stimulates more production
• Creates occlusion effect

5. Age-Related Factors

• Elderly: Wax becomes drier, harder
• More ear hair (especially men) – traps wax
• Reduced self-cleaning – less jaw movement

6. Occupational/Environmental

• Dusty Environments: Construction workers, farmers
• Headphone/Earplug Use: Musicians, factory workers

Symptoms of Earwax Impaction

Primary Symptoms:

1. Hearing Loss (Conductive Type):

• Usually gradual onset
• Can be sudden if water enters (wax swells)
• Mild to moderate degree (20-40 dB typically)
• Improves immediately after wax removal

2. Ear Fullness/Blocked Sensation:

• Feeling of “something inside”
• Pressure sensation
• Own voice sounds louder (autophony)

3. Tinnitus (Ear Ringing):

• Usually low-pitched sound
• Due to wax touching eardrum
• Resolves after removal

4. Itching (Pruritis):

• Dry wax irritating canal
• Can lead to more cotton bud use – vicious cycle!

Secondary Symptoms:

• Earache: If wax pressing on drum या canal inflamed
• Dizziness: Rare, if wax touching drum
• Cough (Reflex Cough): Vagal nerve stimulation

Complications of Neglected Impacted Wax

1. External Otitis

• Trapped moisture under wax
• Bacterial/fungal overgrowth
• Pain, discharge, swelling

2. Tympanic Membrane Perforation

• Forceful self-cleaning attempts
• Pressure necrosis from chronic impaction

3. Hearing Aid Malfunction

• Wax entering hearing aid
• Damages microphone, speaker
• Costly repairs

4. Diagnostic Errors

• Can’t examine ear properly if canal blocked
• Underlying pathology missed

Diagnosis at Prime ENT Center

1. Clinical History

• Onset and duration of symptoms
• Ear cleaning practices (cotton bud use?)
• Hearing aid use
• Previous ear problems
• Occupational/environmental exposure

2. Otoscopic Examination

Prime ENT Center में high-quality otoscopes और otoendoscopes से detailed examination:

Findings in Earwax Impaction:

• Visualization: Wax plug partially या completely occluding canal
• Color: Yellow, brown, black, या white depending on age and type
• Consistency: Soft, hard, flaky assess किया जाता है
• Adherence: Loose या stuck to canal wall/drum?
• Secondary Changes: Canal inflammation, maceration (if wet)

3. Audiometry (If Needed)

• Pre-removal hearing assessment
• Confirms conductive hearing loss
• Post-removal comparison

Safe Earwax Removal at Prime ENT Center

Method Selection Criteria

डॉ. हर्षिता सिंह और डॉ. प्रतीक पोरवाल patient-specific factors के आधार पर method choose करते हैं:

• Wax consistency (soft/hard)
• Amount of wax
• Patient age और cooperation
• Previous ear problems
• Hearing aid user या not

1. Microsuction – Gold Standard at Prime ENT Center

What is Microsuction?

Microscope या endoscope के under, fine suction tube से wax को gently remove करना।

Advantages:

• Safest Method: Direct visualization throughout
• No Water Used: Safe even with eardrum perforation
• Quick: Usually 5-10 minutes
• Painless: No discomfort (slight sound sensation)
• Complete Removal: Better than other methods
• Immediate Relief: Instant hearing improvement
• Can Remove Hard Wax: No pre-softening needed often

Procedure:

1. Patient sits comfortably
2. Microscope/endoscope positioned
3. Fine suction tip (2-3 mm) inserted gently
4. Wax suctioned out under vision
5. Complete canal cleaning
6. Eardrum inspection
7. Usually both ears done in one sitting

Patient Experience:

• Slight tickling sensation
• Humming/vacuuming sound (temporary)
• No pain typically
• Immediate clarity of hearing post-procedure

2. Endoscopic Wax Removal with Instruments

When Used:

• Hard, impacted wax
• Foreign body along with wax
• Wax stuck to drum

Instruments:

• Jobson Horne Probe: Ring curette for scooping
• Wax Hook: For pulling out wax
• Crocodile Forceps: For grasping wax pieces

Procedure:

• Under endoscopic/microscopic vision
• Gentle manipulation
• Wax delivered out in pieces
• Takes slightly longer than suction
• Minimal discomfort

3. Syringing (Irrigation) – Selected Cases Only

When Used:

• Soft wax
• No history of ear disease
• Intact eardrum confirmed
• No recent ear surgery

Contraindications (When NOT to Use):

• Tympanic membrane perforation
• Previous ear surgery (mastoidectomy, etc.)
• Acute otitis externa
• Very hard, impacted wax (may fail)
• Only hearing ear (risk too high)

Procedure:

• Warm water (body temperature – 37°C) in syringe
• Patient’s head tilted
• Water directed along canal wall (NOT directly at drum)
• Wax flushes out
• Canal dried after

Possible Side Effects:

• Temporary dizziness (if water too cold/hot)
• Mild discomfort
• Water retention (rare)

4. Wax Softening Drops (Cerumenolytics)

When Used:

• As pre-treatment before removal
• Hard, impacted wax
• Extensive wax

Types:

• Oil-based (olive oil, almond oil)
• Water-based (sodium bicarbonate)
• Proprietary drops (as prescribed)

Use:

• 3-4 drops in affected ear
• Lie on side for 5-10 minutes
• 2-3 times daily for 3-5 days before removal
• Makes wax soft, easier to remove

Note: Drops alone rarely remove wax completely – professional removal needed।

Post-Removal Care

• Keep ear dry for 24 hours
• No cotton buds!
• Mild discomfort normal for few hours
• If pain, discharge develop → contact clinic
• Hearing improvement immediate usually

Prevention – How to Avoid Earwax Problems

1. STOP Using Cotton Buds

यह सबसे important advice है:

• Cotton buds केवल outer ear cleaning के लिए
• NEVER insert into canal
• Let natural self-cleaning work

2. Cleaning the Right Way

• Clean only outer ear with washcloth
• During bathing, let some water enter and drain naturally
• Dry outer ear gently
• No sharp objects, pins, keys!

3. For Hearing Aid Users

• Remove aids at night (gives ear “breathing time”)
• Clean aids regularly
• Professional ear cleaning every 3-6 months
• Use protective filters on aids

4. High-Risk Groups – Regular Checkups

• Elderly: Every 6 months
• Hearing Aid Users: Every 3-6 months
• Narrow Canals: As advised
• Dusty Occupations: Every 4-6 months

5. When to Seek Help

• Feeling of blockage
• Hearing decrease
• Tinnitus
• Discomfort
• Before audiometry (wax can affect results)
• Before flying (impacted wax + pressure change = pain)

Myths vs Facts about Earwax

Myth 1: “Earwax is dirty, needs regular cleaning”

Fact: Earwax is natural, protective, and mostly self-cleaning। Regular cleaning not needed।

Myth 2: “Cotton buds are made for ear cleaning”

Fact: Cotton buds are for makeup, first aid – NOT for ear canals। Packages often have warning!।

Myth 3: “Ear candling removes wax”

Fact: Ear candling is DANGEROUS, ineffective, can cause burns, wax deposition। Never use!।

Myth 4: “Home remedies work well”

Fact: Professional removal safest। Home remedies can worsen problem या cause injury।

Myth 5: “Wax removal is painful”

Fact: Professional microsuction is painless, quick। Only slight sensation।