Serial plug ( Latin cerumen ) - a condition in which, due to an increase in the amount and compaction of earwax, an obstruction of the external auditory canal occurred. [one]
Earwax formation is a normal physiological process. Earwax is a substance secreted by sulfuric or ceruminous glands located in the cartilage of the external auditory canal . This is a mixture of secretion of sulfuric, sebaceous glands and desquamated epithelium [2] . It mainly consists of fats , proteins , saturated and unsaturated long chain fatty acids , cholesterol and mineral salts , as well as substances that have an antibacterial effect: lysosomes and immunoglobulins . Earwax ensures the normal functioning of the hearing organ due to its purification, moisturizing and protection from the negative effects of exogenous physicochemical and biological factors. Normally, earwax is removed spontaneously during movements of the temporomandibular joint during conversation, chewing, etc. However, the formation of sulfuric plugs is observed when cleaning with preventive purposes with cotton buds. They remove part of the sulfur, but at the same time, most of it moves closer to the eardrum , and it also becomes denser, which in fact is the cause of the sulfur plug in this case. [one]
Sulfur plug develops with the accumulation of earwax in the bony part of the external auditory meatus , in close proximity to the eardrum , from where its natural removal is impossible. This leads to conditions that violate the process of self-cleaning of the external auditory canal (for example, otitis media, dermatitis, eczema), excessive formation of earwax and improper hygiene. Factors contributing to the occurrence of sulfur plug include:
- features of the anatomical structure of the external auditory meatus (narrow, convoluted);
- dense hair growth in the auditory canal;
- elderly age;
- work related to changes in the characteristics of the environment (elevated temperature or humidity, increased or decreased atmospheric pressure, etc.);
- work related to dust (cement or flour dust, sandblasting, etc.);
When using a hearing aid or headphones and telephone headsets, the risk of sulfur plug formation is also increased due to constant irritation of the external auditory canal and impaired earwax removal [3] . The most common reason for the formation of sulfuric cork is improper hygienic care, unreasonably frequent and incorrect use of cotton buds and other improvised means (matches, hairpins, etc.) for preventive purposes. Earwax removal with an auricle toilet should only be done around the entrance to the ear canal. If the cotton swab is inserted deeper, irritation and injury to the skin of the ear canal occurs, sulfur is displaced deeper to the eardrum, and it is “rammed”. Subsequently, earwax is condensed and cork is formed. The introduction of a cotton swab deep into the ear canal is also dangerous because it can cause damage to the eardrum [4] .
Depending on the consistency of the sulfuric cork emit:
- Soft:
- pastelike: painted in light yellow or dark yellow color and have a soft, moderately flowing texture resembling fresh honey;
- plasticine-like: painted in various shades (from the lightest to the darkest) of brown color and have a viscous but pliable consistency;
- Dry: painted in dark brown or black and have a hard and dense texture.
In people of the Mongoloid race and Native Americans, a dry type of earwax is more often observed, in representatives of the Caucasian and Negroid race, a mild type is more common. It is assumed that the type of earwax is genetically determined, and the gene responsible for this is located on chromosome 16 (16q11.2-16q12.1) [5] [6] .
The consistency of the cork also depends on the time it was in the ear canal. Initially, any cork has a pasty consistency. The longer the plug is in the ear canal, the denser it becomes. Sulfur plug may be located in the external auditory canal of one or both ears, blocking its lumen in whole or in part. [one]
Content
Clinical manifestations
Sulfur cork can exist asymptomatically for a long time, until it completely covers the lumen of the external auditory canal. Usually this occurs when water enters the ear, as a result of which the accumulated sulfur swells. Clinically, this manifests itself in the form of a decrease in hearing acuity, a feeling of stuffiness, ringing / hum / noise in the ear, and in some cases, pain in the ear canal. If the cork presses on the eardrum, reflex symptoms such as headache, dizziness, nausea, cough, and sometimes cardiac abnormalities may appear. In such cases, you need to see a doctor, since prolonged contact of the sulfuric plug with the eardrum can lead to the development of inflammation in the middle ear [4] [7] .
Treatment
The treatment for sulfur cork is to remove it. There are two methods for removing sulfur plugs: physical, or mechanical removal and dissolution. Sometimes both methods are used in combination [1] [8] .
Mechanical removal includes:
- flushing: if the sulfur plug is of a soft consistency, it is removed by washing with warm water or saline using a Janet syringe. Under the pressure of water, sulfur is washed out of the ear canal.
- aspiration: in some cases, sulfuric masses can be aspirated using an electric suction pump. However, this technique is possible only with a fairly soft consistency of sulfur masses [6] .
- curettage: dry removal of sulfuric plugs using a special ear probe ( curette ) under visual control. [4] [7] .
Dissolution (cerumenolysis): toilet method of the external auditory canal, based on the introduction of substances that soften or dissolve earwax into the external auditory canal. The cerumenolytics used at home to remove sulfur plugs can be divided into 5 groups: water-based, oil-based preparations that do not contain water or oil [9] , surfactants and agents that soften and promote the extraction of earwax due to vacuum.
- Water-based products:
- Natural sea water (AQUA MARIS OTO, Audispray);
- Solvents
- Chlorobutanol (Otinum);
- Glycerin (Glycerin, Bakhona drops ( lat. Guttae Bachoni ), Drops for ears En'jee);
- Triethanolamine (Cerumenex)
- Sodium bicarbonate (Hydrogen peroxide 3%, drops of Bakhona, Drops for ears En'jee);
Mechanism of action: these agents only soften earwax and do not solve the problem in the case of dense or large sulfur plugs requiring mechanical intervention [10] .
- Oil-based products
- Paraffin (Klin-Irs);
- Olive Oil (Vaxol);
- Mink oil (Remo-wax);
- Almond oil (Cerustop);
- Rose oil (alkaline liquid ( lat. Liquor alkalinus ));
- A mixture of almond, peanut and camphor oil (Earex).
Mechanism of action: lubricate and soften earwax, but do not break down its components. The therapeutic effect is similar to water-based drugs.
- Not containing water or oil:
- Carbamide peroxide (Debrox, Auro, EPO, Murein and Drops, Murein and Wax Rimuvl);
Mechanism of action: softens earwax. The therapeutic effect is similar to water and oil based preparations.
- Carbamide peroxide (Debrox, Auro, EPO, Murein and Drops, Murein and Wax Rimuvl);
- Surfactants:
- A-Tserumen
Mechanism of action: surfactants, surfactants, “stick” to the surface of the sulfuric plug and destroy it due to hydration and cell lysis, thus reducing the density of the sulfuric plug and contribute to its complete dissolution and elimination from the ear canal [6] .
- A-Tserumen
- Softening and promoting the extraction of earwax due to vacuum:
- Phytocandles consisting of beeswax and essential oils.
Mechanism of action: local thermal action and mild vacuum therapy. Their use is dangerous due to the possibility of a burn of the external auditory canal and perforation of the tympanic membrane. [one]
- Phytocandles consisting of beeswax and essential oils.
Prevention
Prevention of the formation of sulfur plugs is the correct toilet of the auricle. To do this, it is good enough to wipe it with a towel after washing or instill cerumenolytic drugs, for example, A-cerumen, in your ears several times a month. The use of cerumenolytic drugs is the only effective and safe way to prevent sulfur plugs in people who have an increased risk of their formation [6] . Their use is advisable, including after being in dusty places or prolonged contact with water, as well as when using a hearing aid, headphones or a telephone headset. [one]
Notes
- ↑ 1 2 3 4 5 6 Sulfuric plug in the ear! How to get rid // Health Internet portal
- ↑ Alvord L. S., Farmer B. L. Anatomy and orientation of the human external ear // Journal of the American Academy of Audiology , 1997, 8 (6). - P. 383-390. - PMID 9433684 .
- ↑ Chou R., Dana T., Bougatsos C., Fleming C., Beil T. Screening for Hearing Loss in Adults Ages 50 Years and Older: A Review of the Evidence for the US Preventive Services Task Force // Annals of Internal Medicine 2011, 154 (5). - P. 347-355. - DOI : 10.7326 / 0003-4819-154-5-201103010-00009 . - PMID 21357912 .
- ↑ 1 2 3 Palchun V.T., Kryukov A.I. Otorhinolaryngology. - Kursk: KSMU; M .: Litera, 1997 .-- 509 p. - ISBN 5-7487-0058-1 . - S. 316-317.
- ↑ Tomita H., Yamada K., Ghadami M., Ogura T., Yanai Y., Nakatomi K., Sadamatsu M., Masui A., Kato N., Niikawa N. Mapping of the wet / dry earwax locus to the pericentromeric region of chromosome 16 // Lancet , 2002, 359 (9322). - P. 2000-2. - DOI : 10.1016 / S0140-6736 (02) 08835-9 . - PMID 12076558 .
- ↑ 1 2 3 4 Karpova E.P., Tulupov D.A., Bochorishvili G.V.Sulfur caps. A practical guide. - M. , 2011.
- ↑ 1 2 Armstrong C. Diagnosis and management cerumen impaction // American Family Physician , 2011, 11 (6). - P. 1011-1013.
- ↑ Riviello R. J., Brown N. A. Otolaryngologic procedures // Clinical Procedures in Emergency Medicine. 5th edition / Ed. by J. R. Roberts and J. R. Hedges. - Philadelphia: Saunders / Elsevier , 2010 .-- 1391 p. - ISBN 978-1-4160-3623-4 . - P. 1178-1216.
- ↑ Roland PS, Smith TL, Schwartz SR, Rosenfeld RM, Ballachanda B., Earll JM, Fayad J., Harlor AD Jr., Hirsch BE, Jones SS, Krouse HJ, Magit A., Nelson C., Stutz DR, Wetmore S. Clinical practice guideline: cerumen impaction // Otolaryngology - Head and Neck Surgery , 2008, 139 (3, Suppl. 2). - P. S1 — S21. - DOI : 10.1016 / j.otohns.2008.06.0.026 . - PMID 18707628 .
- ↑ Wilson P. L., Roeser R. J. Cerumen management: professional issues and techniques // Journal of the American Academy of Audiology , 1997, 8 (6). - P. 421-430. - PMID 9433688 .
Literature
- Sulfur cork // Brief Medical Encyclopedia. T. 3 / Ch. ed. B.V. Petrovsky. - M .: Sov. Encyclopedia , 1974.- 544 p. - S. 56.