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The ear canal may be obstructed by cerumen (earwax), insertion of a foreign object, or an insect. Itching, pain, and temporary conductive hearing loss may result. Most causes of obstruction are readily apparent during otoscopic examination. Treatment is manual removal.
Cerumen:
Cerumen may get pushed further into the ear canal and accumulate during ill-advised attempts to clean the ear canal with cotton swabs, resulting in obstruction. Cerumen solvents (hydrogen peroxide, carbamide peroxide, glycerin, triethanolamine) may be used to soften very hard wax before irrigation or direct removal. However, the prolonged use of these agents may lead to canal skin irritation or allergic reactions. Although cerumen may be removed by irrigation, rolling the cerumen out of the ear canal with a blunt curet or loop or removing it with a suction tip (eg, Baron, size 7 French) is quicker, neater, safer, and more comfortable for the patient. Irrigation is contraindicated if the patient has a history of otorrhea or perforation of the tympanic membrane; water entering the middle ear through a perforation may exacerbate chronic otitis media.
Foreign bodies:
Foreign bodies are common, particularly among children, who often insert objects, particularly beads, erasers, and beans, into the ear canal. Foreign bodies may remain unnoticed until they provoke an inflammatory response, causing pain, itching, infection, and foul-smelling, purulent drainage. A foreign body in the ear canal is best removed by reaching behind it and rolling it out with a blunt hook. Forceps tend to push smooth objects deeper into the canal. Unfortunately, a foreign body lying medial to the isthmus (the bony cartilaginous junction of the external auditory canal) is difficult to remove without injuring the tympanic membrane and ossicular chain. Metal and glass beads can sometimes be removed by irrigation, but hygroscopic foreign bodies (eg, beans or other vegetable matter) swell when water is added, complicating removal. A general anesthetic may be needed when a child cannot remain still or when removal is difficult, threatening injury to the tympanic membrane or ossicles. Further, if manipulating a presumed foreign object results in bleeding, immediate otolaryngologic consultation should be sought. Bleeding may indicate a mucosal polyp originating in the middle ear, which may be attached to the ossicles or facial nerve.
Insects in the canal are most annoying while alive. Filling the canal with viscous lidocaine kills the insect, which provides immediate relief and allows the immobilized insect to be removed with forceps.
Last full review/revision July 2008 by Eiji Yanagisawa, MD
Content last modified July 2008
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