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Ria Mediana09/289473/KU/13473

Group 13308

The external ear canal is a tube like structure,

at the bottom of which is the tympanic membrane.

The ear canal is blind-ended so nothing can pass through to keep it clean. It must stay open to allow sound to pass freely through tympanic membrane.

Introduction

Review anatomy

The earwax is deposited along the canal by

tiny structures called ceruminous glands. Cerumen forms when glandular secretions from the outer one-third of the ear canal mix with exfoliated squamous epithelium.

Each ear canal contains between 1000 to 2000 ceruminous glands. These glands are similar to the apocrine sweat glands (underarm)

Cerumen is composed of secretions and

sloughed epithelial cells and hair from the external auditory canal.

It protects the skin in the canal and is naturally extruded.

However, cerumen may accumulate and occlude the canal of one or both ears, causing discomfort, hearing loss, tinnitus, dizziness, and chronic cough.

Introduction

Normally, cerumen is eliminated or expelled

by a self-cleaning mechanism, which causes it to migrate out of the ear canal, assisted by jaw movement

The old cerumen is moved through the ear canal by motions from chewing and other jaw movements and as the skin of the ear canal grows from the inside out

Ceruminous glands work in concert with

sabaceous glands to produce small peptides, and waxy/oily substances such as fatty acids, sebum, squalene, and cholesterol.  

The ear canal is not easily cleaned from the

outside, so it depends on the system of epithelial migration to clear the sloughed skin layers. The skin cells that are sloughed off (a process called skin desquamation) can accumulate in the cerumen that is deposited on the surface.

If it didn’t clean itself out, the outer layers of skin constantly peeling off accumulate block! symptoms appear

So the components of earwax are shed layers

of skin, with 60% of the earwax consisting of keratin, 12–20% saturated and unsaturated long-chain fatty acids, alcohols, squalene and 6–9% cholesterol

Components of earwax

Accumulation of cerumen that causes

symptoms, prevent a needed assessment of the ear canal/tympanic membrane or audiovestibular system, or both

Cerumen Impaction

Older age Abnormally narrow or misshaped ear canal

earwax has more difficulty being expelled Hairy ear canal Hearing air wearers Use of cotton-tip applicators (Q-tips) earwax

actually pushed deeper blockage! Psoriasis or seborrhea in the ear canal History of previous earwax impactions

Risks

Impaired hearing Feeling fullness in the ears Itching and/or ringing in the ears (tinitus) Ear pain (otalgia) Cough

Sign and symptoms

Direct visualization with an otoscope

Diagnosis

Nama : RK Umur : 5 tahun Alamat : Jalan Teratai 4/89

Condongcatur Pekerjaan : - No RM : 017196xx Tanggal masuk : 25 Februari 2015

Case Report

ANAMNESIS

KU : telinga sakit curiga kotoran RPS : Ortu os mengatakan os sering mengatakan

telinganya sakit dan gatal sudah lama. Ortu os curiga ada sesuatu yang masuk di kuping karena os sering memukul-mukul telinganya seakan-akan ingin mengeluarkan sesuatu. Penggunaan cotton bud untuk membersihkan telinga (+) namun tidak sering. Kemasukan air (-), keluar cairan dari telinga (-). Pendengaran berkurang (-). Keluhan lain pada hidung seperti pilek (-), pada tenggorokan seperti batuk (-)

RPD

Keluhan serupa (-) Alergi (-) Trauma (-)

RPK Tidak ada keluhan

PEMERIKSAAN FISIK

KU : baik, CM Vital sign

TD : 86/55 mmHg N : 109 x/min RR : 20 x/min Suhu : afebris

Ear examination

  Right Left

AuriculaBentuk dan ukutran dalam batas normal, massa (-), hyperemic (-),

Lubang di dekat tragusLymph node no enlargement

Canalis auditorius externa discharge (-) discharge (-)

  hyperemis (-) hypermis (-)

  edema (-) edema (-)

Cerumen block (+) Cerumen block (+)

Tympanic membrane Tidak terlihat Tidal terlihat

Tragus and pinna pain (-) (-)

Tunning fork test Tidak dilakukan

Nose examination

Nose and Paranasal sinuses

Right Left

InspectionSimetris (+), deformitas (-), discharge (-), edem (-), hyperemic (-)

Palpation Tenderness (-), crepitation (-) Tenderness (-), crepitation (-)

Percussion Paranasal sinuses pain (-) Paranasal sinuses pain (-)

Anterior Rhinoscopy = tidak dilakukan Posterior Rhinoscopy = tidak dilakukan

Mouth and throat examination

Findings

Lips Warna dalam batas normal; tidak ada luka

Buccal mucous hiperemic(-); stomatitis (-); massa(-)

Tongue hiperemic(-); massa (-); deformity (-)

Palatum hiperemic(-); mass (-); deformity (-)

Gum edema (-); hiperemic (-); deformity (-)

Tooth carries (-); deformity(-)

Uvula deviation (-); edema (-); hiperemis (-)

Tonsilla T1 – T1 ; hiperemic (-); detritus (-); crypt enlargement (-)

Pharynx Hiperemic (-)

Indirect laryngiscopy = Tidak dilakukan

DIAGNOSIS

Berdasarkan anamnesis dan pemeriksaan fisik, diagnosis pasien Cerumen Prop Auris Dextra Sinistra

TERAPI

Irrigasi

EDUKASI Telinga tidak boleh terkena air Jaga kebersihan telinga, kurangi penggunaan

cotton bud

Discussion

Manual removal using currete, forceps, or

suction Irrigation of the external auditory canal with or

without using ceruminolytics Ceruminolytics

Treatment

Manual removal involves the use of a metal or

plastic loop or spoon. It generally is considered effective, but there are no trials comparing it with other methods for effectiveness or safety

Advantages of manual removal: It does not exposed the ear canal to moisture

and therefore may lessen the risk of infection. Quicker and allow direct visualization of the

procedure via a hand-held monocular otoscope

Manual removal

It involves washing out the ear canal with

water from irrigator or syringe with catheter attached.

The water must be close to body temperature (too cold or too warm can induce dizziness or nauseated)

After the irrigation, the ear canal should be dried out to prevent from infection

Irrigation

Irrigation should not be used if the patient’s

eardrum is ruptured; history of chronic otitis media; myringotomy

3 types of cerumen-softening prearations

Water-based Oil-based Non-water-based/non-oil-based

Ceruminolytics before irrigation may improve irrigation success by as much as 97 percent

Ceruminolytics

In most cases, impacted cerumen is

succesfully removed.

Prognosis

Cotton ear buds are not definitively associated

with cerumen impaction, but they have been implicated in impaction and otitis externa and should be avoided

Ear candling also should be avoided. It actually lead to occlusion with candle wax in persons who previously had clean ear canals.

Complications from ear candling including candle wax occlusion, local burns, and tympanic membrane perforation.

Warning!

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