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Ear Blockages

by Bradley W. Kesser, MD

The ear canal may be blocked by earwax (cerumen), a foreign body, or an insect. These blockages may cause itching, pain, ear fullness, and temporary hearing loss. Before and after attempting to remove earwax, a foreign body, or an insect, doctors may do a hearing test, particularly if the person also complains of hearing loss. If the person's hearing does not return after the blockage is removed, the blockage (or prior attempts to remove it) may have damaged the middle or inner ear. If the person's hearing worsens after the blockage is removed, the removal process may have caused damage. Permanent injury to the ear or hearing is rare if earwax or foreign bodies are removed in a careful and safe manner.

Earwax

Earwax (cerumen) may block the ear canal. Even large amounts of earwax often cause no symptoms. Symptoms can range from itching to a loss of hearing. A doctor may gently remove the earwax with an earwax curette, an instrument with a loop at the end, or a vacuum device. This method is quicker, safer, and more comfortable for a person than the use of water (irrigation), which can be dangerous and is typically not recommended. Irrigation is definitely not used if a person has or has had a perforated eardrum because water can enter the middle ear and cause a middle ear infection. Similarly, irrigation is not used if there is any discharge from the ear, because the discharge may be coming from a perforated eardrum. Discharge from the ear is most safely removed with a small suction device.

Certain solvents (such as hydrogen peroxide, docusate stool softeners, or mineral oil) help soften earwax before the doctor attempts to remove it. These solvents cannot be used long-term, however, because they may cause skin irritation or allergic reactions in the ear canal. People should not attempt removal at home with cotton swabs, bobby pins, pencils, or any other implements. Such attempts usually just pack the earwax deeper into the canal and can damage the eardrum. Soap and water on a washcloth provide adequate external ear hygiene.

Foreign objects

Other blockages can occur when people, particularly children, put foreign objects, such as beads, erasers, and beans, into the ear canal. Foreign objects may remain unnoticed until they cause pain, itching, infection, or a foul-smelling, pus-filled discharge. Usually, a doctor removes such objects with a blunt hook or small vacuum device. Objects with an edge (such as paper) can be removed with small alligator forceps. Objects that are deep in the canal are more difficult to remove because of the risk of injury to the eardrum. A general anesthetic or deep sedation may be needed when a child does not cooperate or when removal is particularly difficult. Sometimes doctors need to use a special operating microscope to see and safely remove the foreign object.

Insects, particularly cockroaches, may also block the ear canal. To kill the insect, a doctor fills the canal with mineral oil or thickened lidocaine, a numbing agent. This measure also provides immediate pain relief enabling the doctor to remove the insect.

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  • XYLOCAINE