Wax is secreted by the ceruminous glands and sebaceous glands present in cartilaginous part of the external auditory canal. Ceruminous gland is also called modified sweat glands.
The sebaceous glands secrete fluids rich in fatty acids while the ceruminous glands secrete fluids rich in lipids and pigment granules. These secretions mix with desquamated epithelial cells and keratin shed from the deep bony meatus and the tympanic membrane to form wax. Wax protects the ear canal by lubricating the ear canal and entraps any foreign material that tries to enter the canal. Normally, a very small of wax is secreted in each ear.
The common causes of wax impaction are:
- Excessive wax secretion.
- Narrow or tortuous external auditory canal.
- Stiff hair or obstructive lesion of the canal.
- Dry dusty environment exposure.
- Hearing impairment- patient usually complain of hearing impairment or blocked ear.
- Pain due to mild Otitis Externa.
- Reflex cough due to stimulation of auricular branch of Vagus nerve.
- Long standing impacted wax results in ulceration of the meatal skin and granuloma formation called wax granuloma.
- Wax softening ear drops: these drops are instilled 6 to 8 times a day for 4-5 days.
- Removal of wax by:
- Syringing of the ear with the help of aural syringe and warm saline or water.
- Removal of wax by jobson horne probe with ring curette. Here the curette is passed distal to the wax and the wax is pulled out.