Schumann Jessica A., Toscano Michael L., Pfleghaar Nicholas
Jefferson Northeast
McLaren Oakland Hospital
Cerumen, or ear wax, is a naturally occurring substance produced at the lateral one-third of the external auditory canal (EAC). Anatomically, this region houses a collection of pilosebaceous glands, including ceruminous glands, hair follicles, and sebaceous glands. The modified sweat produced by the ceruminous glands has bacteriocidal and fungicidal properties, functioning to lubricate and clean the EAC. As dead skin cells slough off and move out of the ear canal, they combine with the oily secretions of sebaceous glands and the modified sweat of the ceruminous glands. The combination of these substances makes up cerumen, consisting primarily of dead keratin cells. Cerumen serves as a protective barrier to trap foreign particles. Several pathologies may present in the EAC, including sebaceous cysts, furuncles, and even glandular tumors, but most commonly plague patients with the buildup and impaction of cerumen. The American Academy of Otolaryngology defines cerumen impaction as "an accumulation of cerumen associated with symptoms, prevents the necessary assessment of the ear, or both." Although cerumen is typically expelled from the EAC spontaneously with jaw movement, this mechanism may fail in some patients and lead to impaction. Impaction is more likely to occur when this normal extrusion of cerumen is prevented in some way, whether that be with the use of hearing aids, persistent use of earplugs or earbuds for noise reduction or music, or by simply attempting to clean the ears with Q-tips or cotton swabs. Common symptoms include a feeling of fullness in the ear, ear pain or otalgia, itchy ear, the sensation of imbalance, cough, and decreased hearing. Roughly 5% of healthy adults, 10% of children, 57% of older persons, and 33% of patients with intellectual disability suffer from impaction of cerumen. Irrigation of the external auditory canal is one of the many options for treating cerumen impaction and a readily available method to general practitioners and emergency rooms. Non-clinicians may perform irrigation, resulting in its advantages and disadvantages. They can be attempted alone or with the pretreatment of a cerumenolytic agent, such as acetic acid, mineral oil, or hydrogen peroxide. It is important to note, however, that a thorough history and physical exam through the use of otoscopy should be obtained to ensure the tympanic membrane (TM) is intact, without perforation or tympanostomy tubes, and to assess for any anatomic abnormalities before any irrigation attempts. If multiple attempts to remove impacted cerumen—including a combination of treatments—are ineffective, clinicians should refer the patient to an otolaryngologist.
耵聍，即耳垢，是外耳道外侧三分之一处自然产生的物质。从解剖学角度来看，该区域有一组皮脂腺，包括耵聍腺、毛囊和皮脂腺。耵聍腺产生的改良汗液具有杀菌和杀真菌特性，起到润滑和清洁外耳道的作用。随着死皮细胞脱落并移出耳道，它们与皮脂腺的油性分泌物以及耵聍腺的改良汗液结合。这些物质的结合构成了耵聍，主要由死亡的角质形成细胞组成。耵聍作为一种保护屏障，可捕获外来颗粒。外耳道可能出现多种病变，包括皮脂腺囊肿、疖肿，甚至腺性肿瘤，但最常见的是耵聍积聚和堵塞困扰患者。美国耳鼻咽喉头颈外科学会将耵聍堵塞定义为“与症状相关的耵聍积聚，妨碍对耳部进行必要评估，或两者兼具”。尽管耵聍通常会随着下颌运动自发地从外耳道排出，但这种机制在某些患者中可能会失效并导致堵塞。当耵聍的正常排出以某种方式受阻时，无论是使用助听器、持续使用耳塞或耳麦来降噪或听音乐，还是仅仅试图用棉签或棉棒清洁耳朵，都更有可能发生堵塞。常见症状包括耳部胀满感、耳痛、耳部瘙痒、失衡感、咳嗽和听力下降。大约5%的健康成年人、10%的儿童、57%的老年人以及33%的智力残疾患者患有耵聍堵塞。外耳道冲洗是治疗耵聍堵塞的众多选择之一，也是全科医生和急诊室容易获得的方法。非临床医生也可以进行冲洗，这有其优点和缺点。冲洗可以单独尝试，也可以在使用耵聍溶解剂（如醋酸、矿物油或过氧化氢）进行预处理后进行。然而，重要的是，在进行任何冲洗尝试之前，应通过耳镜检查获得全面的病史和体格检查结果，以确保鼓膜完整，无穿孔或鼓膜造口管，并评估是否存在任何解剖异常。如果多次尝试清除堵塞的耵聍（包括联合治疗）均无效，临床医生应将患者转诊给耳鼻喉科医生。
