Among the laity, and even in the profession, hardening of the ear-wax is generally regarded as a very harmless affection. It is also considered by many as the most common of all the diseases of the ear. The first treatment that many aural patients receive at the hands of their medical advisers, is a vigorous syringing, or worse still, probing, in order to see if the wax be not hardened. Now the facts are, that inspissation of cerumen is, comparatively, not one of the common affections of the ear, and that when it does actually occur, it is by no means the simple and harmless disease that it is often supposed to be. Of fourteen hundred and forty-eight aural cases observed by myself in private practice, only one hundred and one were what might fairly be said to be cases of inspissated cerumen ; that is to say, cases in which the impaction of ear-wax was the chief cause of the aural symptoms. It would be manifestly incorrect to class cases of chronic ulceration of the middle ear, or cases of chronic non-suppurative inflammation of the same part, in which impacted cerumen was also found, as cases of the last named disease. My classification is founded on the principle that, the hardening of the secretion is not in any fair sense a primary or independent disease, where there is no positive relief either from the tinnitus aurium or impairment of hearing by the removal of the cerumen.
Symptoms of true cases of inspissated cerumen include sudden impairment of hearing, tinnitus aurium, vertigo, and pain in the ear. The appearance of inspissated cerumen is very characteristic: dark brown or black wax that fills the auditory canal. A diagnosis can be obscured by pouring oils into the ear without proper examination.
The removal of impacted cerumen should be performed with a syringe and warm water. In some cases, a solvent like bicarbonate of soda may be used to soften hard wax before syringing. The use of pointed instruments is dangerous except in rare cases where syringing fails. <Callout type="warning" title="Dangerous Procedure">Probing the ear without proper examination can lead to severe complications such as inflammation and perforation of the tympanic membrane.</Callout>
Since some individuals are prone to frequent attacks of inspissated cerumen, it is advisable to have their ears syringed with warm water periodically.
Key Takeaways
- Inspissated cerumen is not as common or harmless as often believed.
- Symptoms include sudden hearing loss, tinnitus, vertigo, and ear pain.
- Safe removal involves syringing with warm water; solvents may be used for hard wax.
Practical Tips
- Avoid pouring oils into the ears without proper examination to prevent obscuring diagnosis.
- Periodic syringing can help manage recurrent cases of inspissated cerumen.
Warnings & Risks
- Probing or probing without visual confirmation risks severe damage such as inflammation and perforation.
- Improper removal techniques may exacerbate symptoms or cause additional complications.
Modern Application
While the methods described for diagnosing and treating inspissated cerumen remain relevant, modern medical practices now emphasize non-invasive diagnostic tools like otoscopes. The importance of proper diagnosis before attempting any treatment remains unchanged.
Frequently Asked Questions
Q: What are common symptoms of inspissated cerumen?
Common symptoms include sudden hearing loss, tinnitus, vertigo, and pain in the ear.
Q: Why is probing without examination dangerous?
Probing without proper visual confirmation can lead to severe complications such as inflammation or perforation of the tympanic membrane.
Q: What is a safe method for removing inspissated cerumen?
A safe method involves using a syringe with warm water; in some cases, solvents like bicarbonate of soda may be used to soften hard wax before syringing.