Ripe Cork

Sulfur plug is an accumulation of earwax in the external auditory canal, obturating its lumen; Observe with hypersecretion of sulfur glands.

Earwax is a mixture of the secretion of sebaceous glands located superficially, as well as sulfuric and apocrine glands located deeper in the skin of the external auditory canal. Sebaceous glands produce sebum (oily substance), while sulfuric glands produce white milk fluid. The composition of sulfur also includes keratin scales. The content of lipids, Ig and lysozyme depends on the nationality. Caucasian and African American peoples produce sulfur with an increased lipid content (wet sulfur), while Asian people have more proteins (dry sulfur). The evolutionary mechanism of the differences is unclear.

Sulfur protects the ear canal from damage. Lipids in sulfuric masses prevent maceration when water enters the external auditory canal. Although in men the pH of the sulfur of the external auditory canal is higher than that of women, in general, the acidic sulfur medium helps to suppress the growth of bacteria and fungi.

ICD-10 code

H61.2 Cork cork.

The problem of sulfur plugs is relevant all over the world. When examining newborns in 20% of cases, cleaning of the ear canal is required. According to Turkish authors, up to 6% of primary school students have sulfur plugs in both auditory canals. About 4% of Ukraine's population suffers from sulfur plugs.

Reasons for the formation of sulfur plugs

The sulfur plugs are an accumulation of earwax, a secretion of sebaceous glands, a desquamated epithelium that is insoluble in water, since it mainly consists of lipids, glycopeptides, hyaluronic acid, enzymes, Ig. Two types of earwax are known: a soft type is observed in Europe and Africa; dry type is typical for Asia and America. There are special types in children: milk plugs due to fluid flow into the ear canal, as well as zidermalnye stoppers in children with trophic disorders. Earwax contains a lot of cholesterol, so an increased amount of it in the blood can also play a role in the formation of sulfuric plugs. The color of the sulfur plug is from yellow to dark brown. Consistency at first soft, waxy, then dense and even stony.

Normally, the earwax is removed by the movements of the anterior wall of the auditory passage during conversation, chewing after the movements of the temporomandibular joint. Delays are facilitated by narrowness and tortuosity of the auditory canal and increased viscosity of sulfur.

The external auditory meatus consists of membranous-cartilaginous (closer to the exit) and bone (located closer to the tympanic membrane) departments. The place of transition of one department to another narrow (isthmus). Sulfur is produced only in the membranous-cartilaginous area, protecting the skin of the ear canal from damage and inflammation. As a result of attempts to "cleanse" the ears with cotton buds and other similar objects, sulfuric masses are pushed through the isthmus, to the tympanic membrane and "pressing" sulfur, which leads to sulfur plugs.

The cause of the formation of sulfur plugs can be hypersecretion of sulfur, narrowness and tortuosity, or inflammation of the skin of the auditory canal, foreign bodies or pollution entering the auditory canal with increased dust content of the air (miners, millers, workers of tobacco factories, etc.). When cleaning the ears, irritation of sulfur glands occurs, which also leads to increased sulfur formation. With hyperfunction of the secretory nerves, there is an increased secretion of cerumen (sulfuric) and sebaceous glands. With eczema, dermatitis, chronic otitis, or after diffuse external otitis, hypersecretion occurs due to irritation of the auditory canal.

Sulfate plug can reach large sizes, but with incomplete obturation, hearing remains normal. Nevertheless, it is enough to get into the ear a small amount of water, as the sulfur swells, which leads to a sudden sharp decrease in hearing, the appearance of a feeling of stuffiness, noise in the ear. Cork can put pressure on the eardrum and cause reflex headaches, dizziness, coughing, nausea, cough reflex, and sometimes cardiac dysfunction.

Diagnosis of sulfuric cork is based on a typical anamnesis and a characteristic otoscopic picture.

The epidermal plug

The cause of the epidermal jam as an independent phenomenon is not fully understood. It contributes to the formation of various chronic diseases of the external auditory canal and middle ear. Some authors associate the formation of the epidermal plug with general biological disturbances in the body and integrate it into the etmoidoantral and congenital bronchiectasis syndrome, which is accompanied by other trophic changes, such as trophic changes in the nails and deformities of the teeth (Hutchinson's syndrome), etc. It is also believed that the epidermal plug can represent one of the signs of congenital syphilis.

Symptoms of the epidermal plug

The epidermal plug is an agglomeration of the scales of the stratum corneum of the epidermis, which are located concentrically on the walls of the external auditory canal and on the outer surface of the tympanic membrane. When otoscopy reveals a whitish or gray mass lining the surface of the external auditory canal, dense at the touch probe probing.

Subjectively, the epidermal plug may manifest as a slight itch or a feeling of fullness in the auditory canal. When obturation of the external auditory canal, pronounced conductive hearing loss occurs on the "causal" ear. As a rule, the process is bilateral, characterized by a prolonged chronic course. The epidermal plug has the property of extensive growth and can penetrate into the ear worse than the ear drum in the process of development, destroying the tympanic membrane.

Differentiate the epidermal plug from the sulfur plug, cholesteatoma of the middle ear, sprouting into the external auditory canal.

Treatment of epidermal plug

Treatment of the epidermal plug is to remove the plug, before which it is softened with keratolytic solutions, including vaseline oil (30 g), salicylic acid (1 g), or a mixture of glycerin and sodium bicarbonate. After the softening of the plug, it is washed in the usual way or removed with the aid of an ear curette. Then the external auditory canal is treated with boric alcohol. Etiotropic and pathogenetic treatment has not been developed.