Impacted earwax occurs when earwax becomes compressed in the ear canal, blocking it. This can cause symptoms like ear pain, fullness, and hearing loss. People more prone to impacted earwax include those with hairy ear canals, who work in dusty environments, the elderly, and hearing aid users. Impacted earwax is typically treated first with ear drops to soften the wax, and then removal either on its own or with irrigation. Nursing care involves examining the ears, assessing any impaction, educating on prevention of insertion of objects in the ear, and examining high-risk groups like the elderly.

1. IMPACTED WAX
Mr. Binu Babu
M.Sc. Nursing
Mrs. Jincy Ealias
M.Sc. Nursing

2.  Ear Wax (Cerumen) is a natural protective oily substance
which is produced in the outer third of the ear canal. It cleans,
protects and lubricates the external ear canal.

3.  Impacted wax is a condition in which cerumen (wax) may
become compressed, thus blocking the ear canal.
 Impaction occasionally occurs, causing otalgia, a sensation of
fullness or pain in the ear, with or without a hearing loss.
DEFINITION

4.  People with large amounts of hair in the ear canal
 Who work in dusty or dirty areas
 Improper cleaning
 The older adult
 Patients with hearing aids
ETIOLOGY

5. Etiological factors
Amount of cerumen secreted is decreased and increased amounts of
keratin
Cause the cerumen to be drier, harder
Impacted cerumen
Block the ear canal
PATHOPHYSIOLOGY

6.  Decreased hearing
 Dizziness
 Ear pain
 Fullness sensation
 Ringing in the ear
 Itching or drainage from the ear canal
CLINICAL FEATURES

7.  History collection
 Physical examination
 Otoscopy
 Audiometry
DIAGNOSTIC MEASURES

8. Medical management
 Ear drops to soften ear wax (ceruminolytics) may be used as
the only treatment in mild cases.
Eg: peroxide in glyceryl (Debrox)
 In more severe cases use of a ceruminolytic ear drop for 4 to
5 days prior to ear irrigation.
 Cerumen may be removed with ear irrigation.
 Instilling a few drops of warmed glycerin, mineral oil, or half-
strength hydrogen peroxide into the ear canal for 30 minutes
can soften cerumen before its removal.
MANAGEMENT

9. If the cerumen cannot
be dislodged by these
methods,
instruments, can be
used such as
Cerumen curette
Aural suction
Binocular
microscope for
magnification
Alligator forceps
/crocodile forceps

10. Nursing management
 Examine the outer ear and the ear canal.
 Assess the level of cerumen impaction.
 Patients with hearing aids should be evaluated for the presence
of cerumen impaction because cerumen can cause feedback,
reduced sound intensity, or damage to the hearing aid.
 Educate the patient not to insert anything into the ear canal,
including, cotton-tipped applicators, hair pins, matchsticks,
safety pins, toothpicks, paper clips, or fingers.
 Older adults should be examined for impacted wax.
 Ear drops can also be used as a preventative measure to avoid
excess cerumen accumulation.