Earwax

On a daily basis, we rarely realize how the world of sound affects the quality of our lives. The reception of auditory stimuli gives us the opportunity for continuous contact with the surrounding space and a sense of security stemming from a constant flow of information about what is happening around us. Thanks to our ability to hear, we can freely communicate with our environment through speech. Hearing impairment worsens the quality of our lives. We don't hear the full sound of our favorite music, we don't feel safe on the streets, and we lose contact with loved ones. We become angry, thinking that others are ignoring us, or we withdraw because we are unsure of what is being said about us.

Hearing is a sense that enables the reception of sound waves. The organs of hearing are called ears. Hearing is used by living organisms for communication and environmental recognition. Sound waves travel through the air to the outer ear, then through the external auditory canal to the eardrum. Under the influence of air vibrations, the eardrum moves the adjacent hammer. Vibrations from the hammer are transmitted to the anvil and stirrup, passing through the oval window into the inner ear, where vibrations are converted into nerve impulses that travel via the auditory nerve to the auditory centers in the brain cortex.

In the initial cartilaginous part of the ear canal, numerous ceruminous glands are located on the side of the auricle. They secrete cerumen - a yellowish or brownish semi-liquid mass, sometimes dry, containing pigment granules, shed epithelial cells, and fat. Its chemical composition prevents the growth of bacteria and fungi. Under normal conditions, cerumen is found only in the cartilaginous part of the ear canal; it does not spontaneously move to its bony part, near the eardrum. Cerumen lubricates the external auditory canal, thereby protecting its skin from minor injuries and preventing water from entering the canal. Foreign bodies entering the ear (e.g., dust particles) are immobilized and then removed from the ear through a self-cleaning mechanism. Cerumen dries into small lumps that move towards the periphery and then fall out of the ear canal.

Some people have narrow or specifically shaped ear canals, so even a small amount of cerumen tends to accumulate in the ear, while in others, cerumen is produced in greater than average amounts. Such a tendency to excessive cerumen secretion may be congenital. The reason for increased cerumen secretion may also be frequent exposure to a polluted environment. Ear canal glands then increase their activity to meet the "greater" task. Increased cerumen secretion can be observed at any age - from infancy to old age. The self-cleaning mechanism may then fail, and there is a tendency to accumulate excess cerumen in the ear. Another significant reason for increased cerumen secretion is mechanical irritation of the ear canal skin, e.g., in users of hearing aids, TV announcers, security personnel, and special services workers who wear an earpiece for most of the day, or in people using cotton swabs for ear cleaning.

It is extremely important not to disrupt the natural mechanism of ear cleaning by using cotton swabs or other objects. This poses a risk of damaging the delicate skin of the ear canal, which can result in bleeding or inflammation of the ear canal. Using swabs generally has the opposite effect of what is intended - instead of cleaning the ear, we push the cerumen deeper into the ear canal, towards the eardrum. Even when we don't insert the swab too deeply, we can damage the delicate eardrum.

Excess accumulated cerumen forms cerumen plugs, which can block the ear canal. Ear canal blockage usually occurs suddenly when the cerumen plug swells or after cleaning the ear with cotton swabs, when the cerumen gets packed in the narrower bony part of the ear canal.

Symptoms of ear canal blockage can be varied, but usually unpleasant enough for the patient to seek urgent ENT care, without waiting until the next day for a doctor's appointment. The primary symptom is a feeling of fullness in the ear and a sensation described by patients as "ear blockage." The sensation of "ear blockage" consists of two elements: sudden deterioration in hearing surrounding sounds and better hearing of one's own voice, especially low tones, sometimes described as "rumbling." The patient feels that they hear their own voice with the blocked ear, while perceiving surrounding sounds with the other ear. The symptoms are often accompanied by a buzzing noise in the ear of an unpleasant, low tone, which significantly intensifies discomfort. When cerumen is pushed towards the eardrum, ear pain and dizziness may occur. The accumulation of cerumen plugs can lead to inflammation of the ear canal skin.

The typical procedure in the case of ear blockage by a cerumen plug is to flush the ear with water under low pressure using a syringe. In some cases, however, this procedure does not produce the desired effect. In such situations, an ENT specialist may use a sharp metal hook or suction device. The ear should not be flushed with water if the cerumen plug is accompanied by inflammation or if the patient has a history of eardrum perforation. Ear flushing, performed by a skilled specialist, is generally not very uncomfortable, except in cases where the cerumen is stuck near the eardrum. Sometimes complications such as irritation or inflammation of the ear canal skin occur. Rarely, eardrum perforation may occur. In some countries, to prevent potential complications, doctors recommend instilling antibiotic drops after ear wax removal.

Patients with permanent hearing damage undergo periodic audiologic examinations. Hearing aid users are more prone to excessive cerumen secretion. Often, a follow-up visit begins with ear flushing. After such a procedure, water often remains in the ear canal, which can adversely affect hearing test results, so it is necessary to wait some time before conducting the tests until the ear canal empties of water.

Hearing is one of the most important senses through which humans perceive and understand the world around them. The human ear is an incredibly complex and delicate "device" that provides uninterrupted communication with the surrounding world every day. It consists of three parts: the outer ear (auricle and external auditory canal), the middle ear (eustachian tube and tympanic cavity with ossicles: hammer, anvil, and stirrup), and the inner ear (the labyrinth containing receptors for the sense of balance and the organ of Corti for hearing). The ear - the path to the mysterious world of sounds where sound, in the form of an acoustic wave, reaches as vibration to the auricle, which directs it to the external auditory canal, causing vibrations of the eardrum, located between the outer and middle ear. In the middle ear, the signal is amplified through the resonance of the three auditory ossicles. The eustachian tube, originating from the middle ear, equalizes the acoustic pressures in the middle ear, protecting the eardrum and oval window from damage. Vibrations of the last auditory ossicle - the stirrup, attached to the entrance to the inner ear, cause movement in the vestibular canal and the space inside the cochlea. The wave traveling through the entire cochlea causes weak vortex currents in the twisted cochlear canal, which move the cilia of epithelial cells of the organ of Corti. The deflection of cilia mechanically stimulates the cells, and impulses from the ear reach the auditory field in the temporal lobe. In practice, the intensity level of acoustic waves is measured using arbitrary units - decibels (dB). The threshold of hearing, above which we begin to hear something, is 0 dB. The noise level of a pneumatic drill is around 110-120 dB, a gunshot or firecracker explosion - 130 dB, and intense street traffic even 90 dB! The maximum sound intensity is 140 dB; above this limit, damage to the organ of Corti occurs, and the pain becomes unbearable.