Impacted cerumen and foreign body ear lecture

2. Wax and Foreign Body EAR
Dr. Junaid Shahzad
M.B.B.S, F.C.P.S
Senior Registrar
ENT and Head and Neck Surgery Department
Al-Nafees Medical College and Hospital
Isra University, Islamabad Campus

3. External Auditory Canal
EAC have 2 parts:
• External 1/3 Cartilaginous
• Internal 2/3 Bony
External part of EAC is lined by skin which contains
hair follicles and ceruminous glands.

4. What is wax?
• Ceruminous gland are modified sebaceous glands.
• They secreats cerumin which combine with
desquamated skin and hair to form WAX.
• Wax varies in colour and consistency.
• Its secretion is controlled by circulating
catecholamine's.
• It is normal to have some wax in the ear canal.

5. Protection and cleaning
 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 ceumin.

6. Impaction
• Wax impaction is common cause of
conductive hearing loss
• If water enters the ear, the
desquamated keratin expands and
leads to impaction of wax.
• This may cause otitis externa

7. Self Cleaning
• Self cleaning by patients invariably
force the ear canal contents deeper
into meatus.
• It can also damage ear lining of EAC or
tympanic membrane
• So use of cotton buds, hair pins, keys
etc. should be avoided.

8. Removal OF WAX
Indications:
Meatal occlusion
Impaction
Irritation
Hearing loss
Otitis externa
Clinical inspection of the ear

9. Methods of cleaning
• Syringing
• Curette
• Suction
Hard impacted wax may need softening
with topical ceruminolytic ear drops
before removal.

10. Keratosis Obturans
• Keratin may desquamate abnormally in
the deep meatus to produce a hard ball
of debris which is difficult to remove.
• This is known as cholesteatoma of ear
canal.
• Removal may need General anesthesia.

11. Complications of wax removal
• Incomplete removal
• Trauma to canal skin
• Perforation of eardrum
• Vertigo

13. Foreign Body EAR
• More common in children
• In adults usually insects or cotton buds
presents as Foreign body in EAC
Foreign bodies can be organic and
non-organic.

14. • Examples of foreign bodies

15. Cont.
Foreign bodies usually lodge lateral to
the isthmus.
Always check both ears and nose also

16. Removal of foreign body
It needs:
• Skill
• Instrument
• Optimal light

17. Multiple attempts in children should
be avoided
Better to give general anesthesia

18. Crocodile forceps

19. Suction Tips

20. Syringe

21. Insects
Insects like fleas, ants or flies may enter ear canal.
They are initially killed by instillation ofAlcohol or
spirit. And then removed.