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Dr. Shakeel AhmedHouse Surgeon

ENT Department, Capital Hospital

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Most common causes of

Conductive Hearing Loss

1.Ear wax impaction2. Otitis Media with Effusion

Department of Oto- Rhino- Laryngology

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Normal Hearing

Outer and middle Ear:

Any abnormality or disease could result in conductive hearing loss

Inner Ear:

Abnormality or disease would result in Sensory Hearing loss

Cochlear nerve and auditory centres:

Abn. or disease would result in Neural hearing loss.

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Ear Wax/ Cerumen

The skin of the external auditory meatus contains lot of sebaceous glands and modified sweat glands- the Ceruminous Glands. Both types of glands contribute to the formation of wax.

In majority, the wax dries and separates as small flakes which fall out of the meatus. However wax may accumulate.

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Clinical Features

SYMPTOMS: Normally this does not give rise to any symptoms, however under

certain circumstances, it produces symptoms. Deafness of short duration and sudden onset is usually due to wax. If wax swells up suddenly by imbibition of moisture from the atmosphere

during rainy season or if water accidently enters the ear during bathing etc, it causes acute pain and even otitis externa.

If wax touches the TM, it can give rise to tinnitus or vertigo. Cough or dyspepsia are occasional effects due to vagal reflex.

ON EXAMINATION: Meatus is seen to contain some black, dark brown or brown material

looking waxy in appearance. Some times it contains lot of shed off epithelial cells and then its colour may be much lighter. It may appear very dry and hard.

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How the ear is kept clean?

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Treatment

No Symptoms : No Treatment

Wax impaction causing symptoms : Removal

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Removal of Wax Two Methods: Wet and Dry

WET METHODIf the wax looks soft and shiny, it can be syringed out at once, but if it is dry and hard, the best plan is to soften it first by instilling warm soda glycerin drops in the ear four times a day for 3-4 days and then syringe it out.

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Syringing Requirements: Aural syringe 50 or 100 cc capacity, a kidney tray

and warm saline at body temperature (Not to produce caloric reaction and vertigo)

Procedure: Patient sits before the operator with the ear to be syringed facing him. The nozzle of the syringe is detached and the syringe is filled with water/ saline. The nozzle is then tightly reapplied and air pushed out of the syringe in vertical position. Light is thrown on to the patient’s ear by means of head mirror/ light. The kidney tray is held below the ear. The pinna of the patient is pulled upwards, backwards and outwards with one hand of the operator to straighten out the meatus and by means of the syringe, the jet of the fluid is ordinarily directed towards the postero-superior wall of the meatus. The force used should be moderate and canal washed of wax. The meatus should be inspected after each syringing to see the TM so that operator does not go on syringing unnecessarily. After syringing, the meatus should be dried with cotton wool on carrier.

Contraindications: Generalized & Localized otitis externa,Perforation of ear drum, Acute otitis media, Scarred ear drum, Recent or old fracture of base of skull, Patient suffering from heart disease for fear of vagal reflex.

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The wax should be removed by means of a wax hook or with the help of a suction machine.

DRY METHOD

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Cleaning of a hearing aid

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Thank you and

over to Dr. Rizwan