Definition

Cerumen impaction, or impacted earwax, refers to earwax that blocks the ear canal. Cerumen production is a natural process that protects the eardrum from infection, foreign substances, dust, water, and insects. Typically, cerumen will naturally go to the ear opening, aided by jaw movements like chewing. However, in some individuals, cerumen does not get expelled naturally and accumulates in the ear, blocking the ear and causing related complaints.

The human ear consists of three main parts: the outer ear, middle ear, and inner ear. Sound vibrations enter the ear, vibrate the eardrum, pass through the middle ear and auditory ossicles, and then are processed in the inner ear. These sound vibrations are converted into electrical signals sent to the brain, which interprets them as sounds.

Cerumen is formed in the ear canal, part of the outer ear. The ear canal contains sweat glands and fine hairs. Cerumen is a combination of dead skin cells, hair, and fluids secreted from the glands that lubricate the ear canal. Cleaning your ears can accidentally push the wax deeper, contributing to earwax blockage.

Cerumen impaction can occur at any age but is more common in children, the elderly, and people with intellectual disabilities due to communicating and attending to their ear symptoms by themselves.

Causes

Earwax, or cerumen, should naturally be able to go to the ear's opening. However, several conditions can cause cerumen impaction, leading to symptoms that could be experienced in the ear:

Cerumen buildup

Cerumen can block the ear if the earwax is pushed too deep into the ear canal, often caused by cotton buds, hearing aids, or earplugs. The cerumen cannot go to the ear opening naturally. Deeply pushed cerumen in the ear will accumulate and block the ear canal, causing symptoms.

Overproduction

If the production rate of cerumen is faster than its natural expulsion rate, it can build up and block the ear canal.

Inadequate cerumen cleaning mechanism

With aging, ear glands will decrease and shrink, producing drier cerumen. Additionally, the small hairs in the ear canal become rougher, hindering cerumen's natural movement out of the ear and leading to accumulation and blockage.

Risk factor

Several factors can increase the likelihood of experiencing cerumen impaction:

• Cerumen impaction occurs more frequently in people with hearing aids, ear plugs, or earbuds.
• People with more fine hairs in their outer ear canal.
• Using cotton buds or inserting other objects into the ears.
• Older individuals or elderly, especially those using hearing aids or with dementia, often have difficulty in cleaning their ears. This can lead to wax buildup and potential hearing loss.
• Individuals with intellectual disabilities may need assistance in cleaning and self-care. Lack of proper ear cleaning can lead to wax accumulation and hearing impairment.
• Some people have ear canals that do not naturally expel cerumen effectively.

Symptoms

The accumulation of cerumen impaction can lead to blockage of the ear canal. Several symptoms could occur as result, including:

• A sensation of fullness or pressure in the ears
• Reduced hearing ability
• Pain in the ear
• Itchiness in the ear 
• Tinnitus or buzzing sounds in the ears

Diagnosis

Medical Interview

The doctor will inquire about symptoms such as fullness in the ears, hearing loss in the affected ear, itchiness, pain, coughing, or tinnitus. They will also inquire about habits and medical history. If the symptoms suggest cerumen impaction, further examination will follow.

Ear Examination

The doctor will examine the ear canal and eardrum using an otoscope equipped with a light and magnifying glass. The otoscope helps visualize any earwax that blocks the ear canal. Generally, no additional diagnostic tests are needed to confirm the diagnosis of prop cerumen.

Management

If your doctor diagnoses you with cerumen impaction, the treatment involves removing the earwax blocking the ear canal. The doctor may use special tools to remove the wax. In cases where the cerumen is located deep inside the ear canal or the consistency is too hard, the doctor may use warm water or prescribe ear drops to soften the wax, making it easier to remove. The ear drops are usually used for three days before a follow-up visit for earwax removal.

For patients with compromised immune systems due to conditions like HIV, diabetes, or cancer, earwax removal must be performed carefully to avoid small wounds that could increase the risk of infection.

Complications

Cerumen impaction can lead to several complications, such as hearing loss, pain, and dizziness. Additionally, the earwax removal process can cause complications if not done carefully. It can cause injuries or tears in the ear canal walls, leading to minor bleeding. This can occur if the earwax is very hard or due to the use of medical instruments.

Prevention

There are steps you can take to prevent cerumen impaction. Do not insert objects like cotton buds deep into the ear canal, especially to clean your ears. Cotton buds should only be used on the outer ear. Cleaning your ears with cotton buds can push the earwax deeper and cause the cerumen to be impacted.

When to see a doctor?

Visit and consult your doctor if you notice symptoms of cerumen impaction or impacted earwax accompanied by:

• Spinning sensation, loss of balance, or inability to walk
• Fever and continuous vomiting
• Sudden loss of hearing ability

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