Sulfur plug

Cerumen plug is a buildup of earwax in the external auditory canal that obstructs its lumen; observed during hypersecretion of the cerumen glands.

Earwax is a mixture of secretions from the sebaceous glands located superficially, and the cerumen and apocrine glands located deeper in the skin of the external auditory canal. The sebaceous glands produce sebum (an oily substance), while the cerumen glands produce a white milky fluid. The composition of the cerumen also includes keratin scales. The content of lipids, Ig, and lysozyme depends on nationality. Caucasian and African-American peoples produce cerumen with a higher lipid content (wet cerumen), while Asian peoples have more proteins (dry cerumen). The evolutionary mechanism for these differences is unclear.

Earwax protects the ear canal from damage. Lipids in earwax prevent maceration when water enters the ear canal. Although men have a higher pH of earwax than women, overall the acidic nature of earwax helps suppress the growth of bacteria and fungi.

ICD-10 code

H61.2 Sulfur plug.

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

Causes of formation of sulfur plug

Earwax plugs are accumulations of earwax, sebaceous gland secretion, and exfoliated epithelium that are not soluble in water, as they mainly consist of lipids, glycopeptides, hyaluronic acid, enzymes, and Ig. There are two types of earwax: the soft type is observed in Europe and Africa; the dry type is typical for Asia and America. There are special types in children: milk plugs due to fluid leaking into the ear canal, as well as epidermal plugs in children with trophic disorders. Earwax contains a lot of cholesterol, so its increased amount in the blood can also play a certain role in the formation of earwax plugs. The color of the earwax plug ranges from yellow to dark brown. The consistency is initially soft, waxy, then dense and even stony.

Normally, earwax is removed by movements of the anterior wall of the ear canal during talking, chewing following movements of the temporomandibular joint. The narrowness and tortuosity of the ear canal and the increased viscosity of the wax contribute to the delay.

The external auditory canal consists of membranous-cartilaginous (closer to the exit) and bony (located closer to the eardrum) sections. The transition point of one section to another is narrow (isthmus). Earwax is produced only in the membranous-cartilaginous section, protecting the skin of the auditory canal from damage and inflammation. As a result of attempts to "clean" the ears with cotton swabs and other similar objects, the sulfur masses are pushed beyond the isthmus, to the eardrum and "pressed" by the sulfur, which leads to sulfur plugs.

The cause of the formation of sulfur plugs may be hypersecretion of sulfur, narrowness and tortuosity, or inflammation of the skin of the ear canal, foreign bodies or dirt entering the ear canal due to increased dustiness of the air (miners, millers, tobacco factory workers, etc.). When cleaning the ears, the sulfur glands are irritated, which also leads to increased formation of sulfur. With hyperfunction of the secretory nerves, there is increased secretion of the cerumenal (sulfur) and sebaceous glands. With eczema, dermatitis, chronic otitis or after diffuse external otitis, hypersecretion is observed due to irritation of the ear canal.

The earwax plug can reach large sizes, but with incomplete obturation, hearing remains normal. However, it is enough for a small amount of water to get into the ear, and the wax swells, which leads to a sudden sharp decrease in hearing, a feeling of congestion, and noise in the ear. The plug can put pressure on the eardrum and cause reflex headaches, dizziness, cough, nausea, cough reflex, and sometimes cardiac dysfunction.

The diagnosis of earwax is made on the basis of a typical medical history and characteristic otoscopic picture.

Epidermal plug

The cause of the epidermal plug as an independent phenomenon has not been fully clarified. Its formation is promoted by various chronic diseases of the external auditory canal and middle ear. Some authors associate the formation of the epidermal plug with general biological disorders in the body and integrate it into the ethmoid-antral and congenital bronchiectatic syndrome, which is accompanied by other trophic changes, such as trophic changes in the nails and dental deformations (Hutchinson syndrome), etc. It is also believed that the epidermal plug may be one of the signs of congenital syphilis.

Symptoms of epidermal plug

The epidermal plug is an agglomeration of scales of the stratum corneum of the epidermis, located concentrically on the walls of the external auditory canal and on the outer surface of the eardrum. Otoscopy reveals a whitish or gray mass lining the surface of the external auditory canal, dense when palpated with a button probe.

Subjectively, the epidermal plug may manifest itself as a slight itch or a feeling of fullness in the ear canal. When the external auditory canal is obstructed, severe conductive hearing loss occurs in the "causal" ear. As a rule, the process is bilateral and is characterized by a long-term chronic course. The epidermal plug has the property of extensive growth and can, in the process of development, destroy the eardrum, penetrate into the middle ear.

Epidermal plug should be differentiated from sulfur plug, cholesteatoma of the middle ear that has grown into the external auditory canal.

Treatment of epidermal plug

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