Ear Wax (Blocked)

Question 1

Wax function

Answer 1

Made in the ear to keep them clean, filter dust and prevent infection.
Too much wax can block the ear

Question 2

Risk factors of too much wax

Answer 2

Over production
Making hard dry wax
Old age as wax gets drier with age
<5 yrs
Small hairy ear canal
Bony ear growths
Putting objects in the ear
Dry skin issues, eczema, psoriasis
Repeated insertion of hearing aids/ ear plugs

Question 3

Symptoms that occur

Answer 3

Earache
Tinnitus
Vertigo
Hearing loss
Full feeling in ear
Itchiness
Ear infection
Blocked ears

Question 4

Diagnosis

Answer 4

Take history - ask symptoms

Use otoscope check the ear canal:
Check good ear 1st then bad, may see brown blackish colour in bad ear.
Look at the tympanic membrane for perforation.

Rinne Weber’s test:
use tuning fork to check sound in ears. (Instructions in pack)
Normal = air conduction > bone conduction
Bad can be conductive hearing loss or sensorineural hearing loss: conductive = bone>air sound heard in bad ear
Sensorineural = air > bone sound heard in good ear

Question 5

Treatment

Answer 5

Don’t try poke things in the ear to remove wax.
Should remove ear wax if:
- Ear wax that’s leading to hearing loss or other symptoms
- Tympanic membrane is obscured by wax but needs to be viewed

How to remove:
Advise use of ear drops to soften wax - aid removal - Options: sodium bicarbonate/olive or almond oil/ ear drops or sodium chloride nasal drops as ear drops. 3-4/day for 3-5 days. and lie with affected ear uppermost 5-10 min

Warm olive oil - softens wax. Then press behind ear to break the wax,
Bulb syringe wash the ear with water breaking wax. use warm water cold water = dizziness

Mechanism of action
Olive oil = Softens wax
Sodium bicarbonate= Dissolves wax
Urea-hydrogen peroxide = Liberates 02 to break up hardened wax
Docusate sodium drops= Softens and breaks up wax

DONT USE EAR DROP IF DRUM IS PERFORATED.

Drops fail = wash out ears with syringe

Question 6

Referral and their treatments

Answer 6

REFER to ENT IF:
dizziness
foreign bodies in ear
ear pain
discharge/blood from ear
deafness/buzzing in ear

ENT TREATMENT:
ear irrigation - pump water in to the ear breaking the wax and washing it out.
micro-suction - suck out ear wax with device
aural toilet - use a loop to scrape wax out