Ear Wax and its Impaction: Clinical Findings and Management

Cerumen, sometimes known as "earwax," is a natural material that cleans, coats, and smooths the external auditory canal. It is the most common cause of ear canal obstruction. While cerumen blockage of the ear canal is usually painless, it can result in a variety of implications, for example, loss of hearing, tinnitus, overflowing, itching, otalgia, discharge, odour, and cough. Ear wax becomes a concern only when it causes hearing loss or other ear-related ailments. Cerumen build-up can arise for various causes, including an inability to self-clear, overproduction or underproduction of its essential components due to delayed skin movement, or mechanical difficulties such as usage of cotton buds or hearing aids. Wax can obstruct the understanding and view of the tympanic membrane and must be gone for investigative purposes or to take imprints before installing hearing support or creating earplugs. Cerumen impaction is usually innocuous; however, it might be associated with more significant symptoms. The removal of affected cerumen is typically regarded safe. However, as eardrum tear, canal laceration, and unsuccessful ear wax elimination. These dangers can be reduced by recognizing risky individuals and customising care measures to their specific needs. All common cerumen removal strategies are Cerumenolytics (ear wax emollient agents), irrigation, and manual elimination. It is also prudent not to interfere if asymptomatic individuals and tympanic membrane visualization are not required.

Tympanic membrane perforation, otitis media and labyrinthitis caused by otomycosis confirmed by intravenous gadolinium 1.5 tesla MRI-a case report

Otomycosis is a fungal ear infection, mostly a superficial mycotic infection of the outer ear canal. The infection may be either subacute or acute but chronic form is around 10%. The characteristic of otomycosis are discharge, pruritus, or more severe discomfort. Here we report a 46-year-old Asian woman presented with vertigo and was diagnosed as otomycosis with the complications of tympanic membrane perforation, otitis media and labyrinthitis of inner ear which was confirmed by IV-Gd 1.5 T MRI. This case is a chronic otomycosis related to cerumen removal two year before this onset. Our study supported the suggestion that otomycosis should include fungal infections of the middle and inner ear, furthermore the infection of the inner ear may be included as labyrinthitis with the symptom of vertigo.

Cerumen Management: An Updated Clinical Review and Evidence-Based Approach for Primary Care Physicians

Objective: To provide family physicians with a practical, evidence-based approach to managing patients with cerumen impaction. Methods: MEDLINE, The Cochrane Library, and the Turning Research Into Practice (TRIP) database were searched for English-language cerumen impaction guidelines and reviews. All such articles published between 1992 and 2018 were reviewed, with most providing level II and III evidence. Results: Cerumen impaction is a common presentation seen in primary care and cerumen removal is one of the most common otolaryngologic procedures performed in general practice. Cerumen impaction is often harmless but can be accompanied by more serious symptoms. Cerumenolytics and irrigation of the ear canal are reasonable first-line therapies and can be used in conjunction or isolation. If irrigation and cerumenolytics are contraindicated, manual removal is appropriate, but the tools necessary are not commonplace in primary care clinics and specialized training may be required to prevent adverse outcomes. Conclusion: Family physicians play a key role in the assessment and management of cerumen impaction and are well equipped to do so. Knowledge of the available techniques for cerumen removal as well as their contraindications ensures that cerumen is removed safely and effectively. When cerumen removal cannot be removed safely in a primary care setting, referral to Otolaryngology-Head and Neck Surgery is appropriate.

Ent Examination and Cerumen Removal in Letjen Jamin Ginting Junior High School, Berastagi

Diseases of ear, nose, and throat (ENT) are common diseases in the world. The diseases are essential due to morbidities, which affect the physiological functions in the head and neck region. Cerumen impaction is the most common finding disease of ENT in children. The community service was done to find the distribution of ear, nose, and throat examination results of students in Letjen Jamin Ginting Junior High School, Berastagi, especially cerumen impaction which then were treated with cerumen removal. The community service also aimed to increase student's knowledge about ENT disease. The ENT examination was done to 188 students. The students with cerumen impaction were treated with cerumen removal. The students also educated about ENT disease to improve knowledge about ENT disease. Among 188 students, the number of male students was more than female with 98 students (52.1%), where 76 students (40.4%) were 14 years old. 150 students (79.8%) did not have any complaint about their ear, nose, and throat. Ear fullness was a common chief complaint from the students with 15 students (8.0%). Ear disease was a frequent disease with 44 students (47.3%) and cerumen impaction as the most common findings with 43 students (22.9%). In ENT disease education, the evaluation was done with the highest result was get by 8 students with 80% corrected answers. Ear disease had high prevalence with cerumen impaction as the most common findings of ENT examination.

A Comparison of National Pediatric Procedures Training Guidelines With Actual Clinical Practice in Ohio

ABSTRACT Background The Accreditation Council for Graduate Medical Education (ACGME) and Pediatrics Review Committee (RC) recommends the clinical procedures residents should master during their training. These guidelines may be partially based on consensus opinion or tradition rather than actual need. The literature defining which procedures general pediatricians actually perform in practice is limited. Objective Our objective was to determine how often general pediatricians perform procedures recommended by accreditation bodies, how well prepared they feel to perform them, and how important the procedures are to their practice. Methods We categorized recommended procedures as emergent, urgent, or office-based, then developed and administered a survey in 2017 based on these classes. We randomly sampled and polled 439 general pediatricians from urban, suburban, or rural regions across central Ohio. Responses were compared using the Welch ANOVA, Mann Whitney U, and post-hoc tests. Results The response rate was 60% (265 of 439). Pediatricians almost never performed 11 of 13 recommended procedures, yet felt well prepared to perform them all and believed that all were important. Rural pediatricians performed significantly more emergent and office-based procedures and rated them as more important. Commonly performed non-ACGME/RC procedures were circumcision, wart removal, cerumen removal, umbilical cauterization, and suture removal. Conclusions Findings suggest that pediatricians rarely perform most of the recommended procedures, but think they are important. There are several office-based non-ACGME recommended procedures that pediatricians commonly perform. Regional differences suggest the need for customized training based on future practice plans.

Effects of a sensory branch to the posterior external ear canal: coughing, pain, Ramsay Hunt's syndrome and Hitselberger's sign

Background:A distinct nerve innervating the external auditory canal can often be identified in close relation to the facial nerve when gradually thinning the posterior canal wall. This nerve has been attributed to coughing during cerumen removal, neuralgic pain, Hitselberger's sign and vesicular eruptions described in Ramsay Hunt's syndrome. This study aimed to demonstrate the origin and clinical impact of this nerve.Methods and results:In patients with intractable otalgia or severe coughing whilst inserting a hearing aid, who responded temporarily to local anaesthesia, the symptoms could be resolved by sectioning a sensory branch to the posterior canal. In a temporal bone specimen, it was revealed that this nerve is predominantly a continuation of Arnold's nerve, also receiving fibres from the glossopharyngeal nerve and facial nerve. Histologically, the communicating branch from the facial nerve was confirmed.Conclusion:Surgeons should be aware of the posterior auricular sensory branch and its clinical implications.