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International Journal of Otolaryngology and Head & Neck Surgery, 2013, 2, 276-279
Published Online November 2013 (
Open Access IJOHNS
Sociodemographic Characteristics and Prevalence of Self
Ear Cleaning in Sokoto Metropolis
Stanley B. Amutta1*, Mufutau A. Yunusa2, Kufre R. Iseh1, Ayodele Obembe2, Enokela Egili3,
Daniel Aliyu1, Mohammed Abdullahi1
1ENT Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2Psychiatry Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
3Family Medicine Department, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
Email: *
Received September 6, 2013; revised October 5, 2013; accepted November 2, 2013
Copyright © 2013 Stanley B. Amutta et al. This is an open access article distributed under the Creative Commons Attribution Li-
cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Self ear cleaning with cotton buds and other objects is a common practice. Objective: To determine the
sociodemographic characteristics and the prevalence of self ear cleaning habit among patients attending a family medi-
cine clinic in a teaching hospital in Sokoto metropolis. Materials and Methods: This was a 4 weeks prospective study
carried out between May and June, 2013 at Usmanu Danfodiyo University Teaching Hospital and Specialist Hospital
Sokoto. A structured self response questionnaire containing items on sociodemographic characteristics, frequency of
administering objects into the ear and complications of self ear cleaning was administered to the respondents after in-
stitutional research ethical clearance. The data were analysed using SPSS for windows version 16.0. P-value was con-
sidered significantly if less than 0.05. Results: A total of 200 subjects were included in this study, comprising of 93
(46.5%) males and 107 (53.5%) females. Their ages ranged from 18 - 57 years with the mean age being 30.29 years
(±8.70). Eighty percent (160) of the respondents practise self ear cleaning. Types of objects included writing objects
and cotton buds. For many of the subjects, the frequency of insertion was once daily and both ears were frequently
cleaned. Complications that have arisen due to the practice included otitis externa. Conclusion: Self ear cleaning was
prevalent in the subjects. Considering the complications that may arise, ear cleaning is better done by trained health
Keywords: Ear; Cleaning; Self; Wax; Cotton Bud; Sokoto
1. Introduction
The habit of cleaning the external auditory canal (EAC)
with cotton buds and other objects is a common practice
[1,2]. Generally, it is done to clean ear wax considered as
dirt from the EAC [1,2]. However, this wax resulted
from combined secretions of the ceruminous and seba-
ceous glands and desquamated epithelium from the tym-
panic membrane and skin lining the external auditory
canal form the ear wax [1,3-7].
Accumulation of ear wax in the EAC is the most
common and routine otologic problem [4]. Ear wax ac-
cumulation obstructed the clinician from viewing the
tympanic membrane, caused ear discomfort, otalgia,
hearing loss, itching, tinnitus and increased infection risk
[4-6]. Rarely, unproductive cough may be the only clini-
cal presentation of impacted ear wax [8]. Some people
make a routine attempt to remove the ear wax using cot-
ton bud, and loose tip cotton swabs, feathers, stick and a
variety of other objects [1,2,4,9]. This act interferes with
the self cleansing function of the EAC and the wax
which is further pushed medially towards the tympanic
membrane [2,4]. Moreover, ear wax habitual removal is a
risk factor for repeated trauma, inflammation and weakens
the EAC local defence against bacterial and fungal infec-
tion [1,2,9].
Previous studies have reported the habit of ear clean-
ing, objects used to clean the ears, and how frequent and
associated with complications [1,2,9]. In Sokoto, North-
Western Nigeria there is no study conducted on self ear
cleaning habit. The purpose of this study was to deter-
mine the sociodemographic characteristics of patients
who practice self ear cleaning habit and associated with
*Corresponding author.
complications in Sokoto metropolis, North-Western Ni-
2. Materials and Methods
This was a prospective study which was carried out over
a 4 weeks period between May and June, 2013 at Us-
manu Danfodiyo University Teaching Hospital (UDUTH)
and Specialist Hospital Sokoto. Usmanu Danfodiyo
University Teaching Hospital and Specialist Hospital are
tertiary and secondary health institutions respectively.
These two institutions are located within Sokoto me-
tropolis. The subjects comprised of both patients and
healthy adults (staff and students) of these institutions.
However for subjects to be included into this study,
should not have ear problems or complaints, give consent
to participate in this study and should not be less than 18
years. Exclusion criteria were individuals less than 18
years of age, having ear problems/complaints and not
giving consent.
A structured self response questionnaire was adminis-
tered to the respondents after institutional research ethi-
cal clearance was obtained for the study and informed
consent. A sample of loose tip cotton bud was shown to
the respondents during the response to the questionnaire
[2], and they were asked if they will replace the tight
cotton bud available in the market with the loose tip cot-
ton bud. Inclusion criteria were being adult and having
given consent to participate in the study.
The data obtained was analyzed using SPSS for win-
dows version 16.0. P-value was considered significant if
it was less than 0.05.
3. Results
A total of 200 subjects participated in this study. The
mean age of the respondents was 30.29 years (±8.70
years). Ninety three (46.5%) were males and 107 (53.5%)
were female, the ratio being 1:1.2.
From Table 1, the respondents were mostly young
people with those in the 21 - 30 years age group com-
prising more than half of them (58.5%). One hundred and
thirty nine subjects were Muslims while 61 were Chris-
tians and more than 60% of them received tertiary educa-
tion. Majority of them were civil servants (42.0%) and
students (42.5%) while Hausa/Fulani ethnic group con-
stituted were 114 (57.0%).
In Table 2, one hundred and sixty (80%) of the re-
spondents practise self ear cleaning while 39 (19.5%) do
not clean their ears. The frequency of cleaning per day in
the subjects were as follows: those who cleaned once
daily were 77 (48.1%), twice 25 (15.6%), thrice 7 (4.4%),
four times 1 (0.6%), five times 2 (1.3%) and more than
five times 48 (30%). Cotton bud was the most common
object used by the subjects to clean their ears with 146
Table 1. The age distribution of the subjects.
Age range Number (%)
18 - 20 16 (8.0)
21 - 30 117 (58.5)
31 - 40 42 (21.0)
41 - 50 17 (8.5)
51 - 60 8 (4.0)
Total 200 (100.0)
Male 93 (46.5)
Female 107 (53.5)
Islam 139 (69.5)
Christianity 61 (30.5)
Primary 15 (7.5)
Secondary 33 (16.5)
Tertiary 124 (62.0)
Postgraduate 28 (14.0)
Civil service 84 (42.0)
Housewife 7 (3.5)
Missionary 1 (0.5)
Self employed 13 (6.5)
Student 85 (42.5)
Teacher 10 (5.0)
(91.2%), followed by biro cover/tip 6 (3.7%) and other
objects were 8 (5.0%) comprising feather 3 (1.9%),
broom stick 2 (1.3%), finger 2 (1.3%) and match stick 1
(0.6%). Removal of dirt 65 (40.6%) was the most com-
mon reason for self ear cleaning among the subjects, fol-
lowed by itchy ears 48 (30%), ear wax 25 (15.6%). The
other reasons included ear blockage 22 (13.8%), water in
the ear 10 (6.2%) and prevention of infection 6 (3.8%).
Both ears were most common frequently cleaned among
the subjects with 89 (55.6%), right ear 47 (29.4%) and
left ear 24 (15%). Only 13 (8.1%) respondents accepted
to replace the cotton bud with a loose tip cotton bud.
Forty (25%) of the 160 respondents involved in the
self ear cleaning had some complications while 120
(75%) had no complications. The most common compli-
cation was otitis externa 17 (10.6%), followed by re-
tained object in the EAC 11 (6.9%), pain 10 (6.3%) and
bleeding from EAC 2 (1.2%).
4. Discussion
This prospective cross sectional study was aimed to de-
termine the sociodemographic characteristics, the preva-
Open Access IJOHNS
Table 2. Self ear cleaning among the subjects.
Self ear cleaning
Yes 160 (80.0)
No 39 (19.5)
Frequency per day
1 77 (48.1)
2 25 (15.6)
3 7 (4.4)
4 1 (0.6)
5 2 (1.3)
>5 48 (30)
Objects used
Cotton bud 146 (91.2)
Biro cover/tip 6 (3.8)
Other objects 8 (5)
Reason for using objects into the ear
Dirt 65 (40.6)
Itchy ears 48 (30)
Wax 25 (15.6)
Other reasons 22 (13.8)
Ear frequently clean
Both 89 (55.6)
Right 47 (29.4)
Left 24 (15)
Nil 120 (75)
Otitis externa 17 (10.6)
Lodge object in the EAC 11 (6.9)
Pain 10 (6.3)
Other complications 2 (1.2)
lence of practising self ear cleaning and previous history
of complications from the habit. Of the subjects 80% of
them indulged in self ear cleaning. In addition, majority
cleaned their ears once daily and both ears were fre-
quently cleaned. Cotton bud was the preferred object for
cleaning the ears among the subjects and the most com-
mon complication encountered was otitis externa.
Self ear cleaning is a common practice. It is usually
done by most people to remove ear wax, which most
individual considered as dirt [1,2]. The prevalence of self
ear cleaning among the respondents in this study was
comparable to previous study in Kaduna, Nigeria [1].
The objects used by the respondents in this study for
self ear cleaning varied. The most common object used
was cotton bud in 91.2% of the respondents involved in
the habit. This is in agreement with numerous studies
[1,2,5,9]. Feathers, biro cover/tips, broom stick, match
sticks and finger were used by few members of the sub-
jects. An unprofessional attempt to clean the EAC is a
potential risk factor for ear trauma and otitis externa
[1-5,9]. Moreover, the risk is greater if done without di-
rect visualization of the EAC, and using wrong instru-
ments or objects not design for removing ear wax or for-
eign body from the ear.
The majority of the subjects in this study clean their
ears 1 - 5 times daily. The breakdown of the frequency of
cleaning revealed 48.1% routinely clean their ears once
daily, while 21.9% clean 2 - 5 times every day and 30%
clean more than five times per day. The rate of cleaning
in this study is similar to other report [1,2]. The compli-
cation of self ear cleaning among the subjects in this
study was 25%. In contrast, Lee, et al. [2] reported from
2% in Malaysia. The larger sample size in this study may
be the possible explanation for this difference. The most
common complication encountered in this study was oti-
tis externa, followed by retained object in the EAC, pain
and bleeding from EAC and ear wax impaction. Similar
complications were reported in other studies [1-5,9,10].
In this study, the most common reason for self ear
cleaning was removal of dirt, followed by itchy ears and
ear wax. Itchy ears were the most common reason re-
ported by Afolabi et al. [1], while ear wax was the pre-
dominant reason in the study by Lee et al. [2]. Majority
of the respondents in this study considered ear wax as
dirt. Ear wax is not dirt, but natural product of the EAC
that prevents infection and foreign bodies from easily
entering the EAC [1-5]. Cleaning the EAC with cotton
bud and other objects is a behavioural factor that con-
tributes to impacted ear wax because the action opposes
the self cleansing property of the EAC, mechanical
trauma to the EAC wall, tympanic membrane perforation
and secondary infection [3-5,9]. The appropriate indica-
tions for ear wax removal include symptomatic ear wax
impaction and to view the tympanic membrane during
ear examination [3,4]. Furthermore, the ear wax removal
should be done by trained and skilled ENT Nurses, Gen-
eral Physicians and Otolaryngologists.
Itchy ears require complete evaluation by an oto-
laryngologist because fungal infection of the external
ears and allergic conditions such as allergic dermatitis
and allergic rhinosinusitis may be responsible. Self ear
cleaning because of blockage as practiced by 6.2% of the
respondents in this study is dangerous due to the risks
mentioned above. Moreover, middle ear lesion that leads
to fluid accumulation in the middle ear such as otitis me-
dia with effusion (OME) presents with sensation of ear
blockage and hearing impairment.
Ironically, 3.8% of the respondents indulged in self ear
cleaning to prevent infection. Health education is indis-
pensable to stop the habit. Another 3.8% cleaned their
EAC to mop out water after bath, overall, only 8.1% of
the respondents agreed to replace the traditional tight
Open Access IJOHNS
Open Access IJOHNS
cotton bud with a loose tip cotton bud despite adequate
explanation that loose tip cotton bud is better because it
absorbs more water and less traumatic. Reason for the
choice of the tight cotton bud was due to its aesthetic
appearance. In contrast, 24% of the subject in the study
by Lee et al. [2] agreed to replace the conventional cot-
ton bud with loose tip cotton bud.
It is important that in the interpretation of the findings
in this study, some limitations present be considered.
This was a hospital based study hence extending the
findings to the community may be difficult. Also the
sampling was mainly convenient and the subjects were
relatively few. In spite of these, this report would appear
as a call to action on self ear cleaning among the Nige-
rian population living in Sokoto metropolis.
5. Conclusion
The present study suggested that self ear cleaning habit is
prevalent in Sokoto metropolis. The complications re-
ported in this study suggested that future study should be
community based on involving larger subjects.
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[2] L. M. Lee, R. Govindaraju and S. K. Hon, “Cotton Bud
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[4] T. T. K. Junk and T. H. Jinn, “Diseases of the External
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[8] F. Jegoux, F. Legent and C. B. de Montreuil, “Chronic
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... The questionnaire was validated by a pilot study on about 15 participants to recognize any issues with the questions and the language to help modify and improve the content. The questionnaire was obtained and collected from Alshehri et al. (21), Amutta et al. (22), and Hobson and Lavy (23). The questionnaire evaluated various aspects, including information regarding sociodemographic factors such as age, sex, and employment status. ...
... Taking into account the practices of self-cleaning the ear among the participants, we found that 54.7% of the participants reported cleaning both outside and inside of the ear, and 93.0% of them reported cleaning both ears equally. This finding is similar to the researchers' observations in previous studies (6,22,28,29). In a previous study by Adegbiji, the authors found that in 51.1% of cases, both ears were cleaned. ...
... In a previous study by Adegbiji, the authors found that the frequency of ear cleaning among the participants was daily at 49.3%, weekly at 17.1%, monthly at 13.3%, and occasional at 20.4% [11]. Furthermore, a study by Amutta found that some respondents frequently cleaned both ears daily (22). ...
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Many people practice placing various things in their ears to remove earwax, known as self-ear cleaning. This study aimed to determine the knowledge, attitudes, and practices of self-ear cleaning of the community in Riyadh, Saudi Arabia. Method: This cross-sectional study was carried out for more than six months. After institutional research ethics approval was obtained for the study, a structured self-response questionnaire was provided to the participants. Results: 631 (70%) participants completed the study questionnaire. More than 42% of the participants agreed or strongly agreed that cotton buds should be used to clean the ears. Most participants disagreed with the statement that it is best not to clean the ears. More than two-thirds (75.8%) of the participants knew that cotton buds could cause ear infections, 78.9% knew that cotton buds could cause eardrum perforation, and 85.6% knew that cotton buds could push ear wax deeper into the ear. Considering the tool used for self-ear cleaning, almost two-thirds (68.6%) re-ported using cotton buds. No complications due to self-cleaning of the ear were reported in 65%, while 16.2% reported pain because of self-cleaning, while 16% of the participants reported otitis externa. Conclusion: The general population in the Riyadh region had a moderate to a good level of knowledge about self-ear cleaning and its complications. However, a low attitude towards cleaning with a cotton bud was the primary tool used to clean the ear. About two-thirds (65%) of the participants reported complications due to self-cleaning. 16.2% reported having pain due to ear self-cleaning. Keywords: Cotton Bud; Ear wax; Self-Ear Cleaning; Saudi Arabia.
... They assume that it is good for ear hygiene and important to remove excess earwax [12,13] besides thinking that cerumen is an infection indication or its impaction causing nuisance and pain for them [14,15]. Unprofessional practice to remove earwax using tools such as cotton buds or matchsticks may lead to different complications such as otitis cerumen impaction, injuries [16][17][18], or otitis externa having a high risk for hearing loss. We can prevent or reduce injuries and symptoms related to ear self-cleaning by educating the public about the danger of ear self-cleaning [12]. ...
... This prevalence seems to be lower than the study of Olaosun et al. who, in their study among Nigerian youths, found that 93.4% of the respondents practiced self-ear cleaning [12]. The higher prevalence was also reported by Afolabi et al. [14] in Kaduna (90%), Amutta et al. [17] in Sokoto (80%), Olajide et al. [18] in Niger state (92.8%), and Lee et al. [19] in Malaysia (92%). On the other hand, the lower prevalence (53%) was reported by Hobson and Lavy in London in their hospital-based study (20) and also by Macknin et al. [21] who found a prevalence of 62% in a pediatric clinic in Cleveland, Ohio, United States. ...
... Hygiene is the most common reason why people tend to clean their ear (45%) in this study which resembles the result of another study [9]. However, other studies indicated that itching and removing dirt and wax from the common ear canal were the most reasons [17]. Cotton bud was the most common tool used by students for self-ear cleaning (78%), mostly practicing it occasionally and cleaning both ears equally form inside and outside. ...
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... Amutta. 2016 [13] also found that self-ear cleaning was widely practiced in a community based study, in all groups in Nigeria, being highest amongst young adults 21-30 years, and higher in university graduates than any other graduates. Oladeji., et al. [5] also found it to be very high (94%) in health workers, which is of concern, considering that they should be practicing safe and healthy ear care methods. ...
... Adebiji., et al. [12] and Afolabi [1] also found that the frequent use of cotton buds is associated with some ear diseases such as wax impaction, ear infection, facial nerve palsy, dizziness, perforation of the ear drum, perilymphatic fistula, trauma to the ear canal, and deafness The knowledge and awareness of ear care practice in rela-tion to wax removal, the main object of self-ear cleaning however is still lacking. Non-hygienic individual behaviors and habits like inserting unsterile foreign objects still prevalent [13]. ...
... The most prevalent users of cotton buds were adults in the 21-30-year-old age group. The prevalence rate of cotton bud use in our study is lower than those reported in two studies conducted at the Aminu Kano Hospital [13] and Sokoto metropolis, [7] which reported rates of 76.3% and 91.2%, respectively. In addition, a higher prevalence of cotton bud usage was reported in females in Nigeria than in this study. ...
... Most of the participants in this study cleaned their ears with cotton buds on a weekly or monthly basis, while another study reported that the majority of cotton bud users cleaned their ears daily. [7] Interestingly, a study conducted at Corps Camp in Nigeria showed a high prevalence of cotton bud usage (93.4%) and a About 18% of the respondents in our survey reported complications from the use of cotton buds. Interestingly, only 9.3% did so in a study conducted at Jos University Teaching Hospital. ...
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... Similar findings can be depicted from Nigeria where self-ear cleaning using cotton buds was the commonest risk factor. 12 The low prevalence of OE found in Sokoto study could be to the fact that the subjects interviewed were those who attended family medicine clinic so they are less likely to have risks related to ears and hence a low prevalence compared to the subjects in this study. High percentage of habitual use of cotton buds for ear cleaning were also reported elsewhere. ...
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p class="abstract"> Background: Otitis externa is among the otological diseases with significant impact on the quality of life of sufferers. Little is known in Sub Saharan countries despite being the focus of such disease. The study aimed to determine the prevalence and clinical characteristics of otitis externa at Muhimbili National Hospital, Tanzania’s largest tertiary hospital. Methods: This was a hospital based descriptive cross sectional study where 1200 participants were recruited from June 2016 to January 2017. Data was analyzed using SPSS program version 20. Results: A total of 1200 patients were recruited in this study and majority 601(50.1%) were females. Majority 672(56%) were in age group 0–10 years. Among 1200 patients, 138 (11.5%) were diagnosed to have otitis externa and male predominance (55.1%) was found. Majority 120 (87%) had diffuse otitis externa and with 0-10 years (25.83%) being the commonly affected age group by variant. The commonest risk factor was self-ear cleansing 87(53.7%) and only 2.9% were found to have complications of otitis externa. Conclusions: Otitis externa was found to be prevalent and with male predominance. Self-ear cleansing was the commonest risk factor. Complications of otitis externa were found to be rare. Public awareness on otitis externa should be advocated in our country.</p
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Introduction: Ear care is a part of social cleanliness. It may not demand much care but proper and adequate care is essential to protect the optimal functions. The knowledge and awareness of ear care practice however is still lacking. Non –hygienic individual behaviors and habits like penetrating foreign objects, exposure to loud noise may affect the human ear. Lack of proper ear care may lead to many diseases and its complications.. Objectives : To assess the knowledge attitude and practice of ear care of pre clinical medical students attending Birat Medical College. To correlate the knowledge, attitude and practice of ear care of pre clinical medical students. Methodology: A descriptive cross sectional study was done in 151 students of pre clinical sciences of Birat Medical College for a period of two months from 15th Sept 2020 to 15 November, 2020. After the ethical clearance a specifically designed semi structured questionnaire containing yes and no questions was prepared in goggle form and distributed among all the pre clinical medical students of Birat Medical College Teaching Hospital students and then their response was evaluated. Result: Students of pre clinical sciences had good knowledge, attitude and practice of ear care. Significant correlation was seen between knowledge and practice and also between knowledge and attitude. However there was no significant correlation between attitude and practice. Conclusion: Overall knowledge, attitude and practice of preclinical medical students of Birat Medical College was good. Surprisingly students showed poor knowledge, attitude and practice in few individual questionnaires which was hoped that the medical students know more than lay individual in the society
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In the UK, some 2.3 million people suffer cerumen ('ear wax') problems serious enough to warrant management, with approximately 4 million ears syringed annually. Impacted cerumen is a major cause of primary care consultation, and a common comorbidity in ENT patients, the elderly, infirm and people with mental retardation. Despite this, the physiology, clinical significance and management implications of excessive and impacted cerumen remain poorly characterized. There are no well-designed, large, placebo-controlled, double-blind studies comparing treatments, and accordingly, the evidence surrounding the management of impacted cerumen is inconsistent, allowing few conclusions. The causes and management of impacted cerumen require further investigation. Physicians are supposed to follow the edicts and principles of evidence-based medicine and clinical governance. Currently, in patients with impacted cerumen, the lack of evidence makes this impossible.
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Complications that arise from self-cleaning the external ear canal are common. This is a prospective study using standard questionnaire on the practice of ear cleaning in 50 subjects. A loose tip cotton bud was also shown to them to assess if it was acceptable to replace their current cotton bud. Thirty six percent of them clean their ears by introducing an object into the ear canal once or more a day. The commonest reason to clean the ears was the presence of earwax. Only 6% used a cotton bud to mop fluid from the ear canal. Almost all (92%) the subjects used a cotton bud to clean the ear. A complication rate of 2% was noted. A loose tip cotton swab was shown to the subjects. Despite explaining that it is safer and better, only 24% of the subject were willing to change to this loose tip cotton bud. Seventy four percent of the subjects cleaned their ear regularly because of earwax. The misconception of needing to clean the ear canal by introducing an object into the ear is rampant. This practice should be avoided and health care providers can play an important role in this.
Objectives: Impacted cerumen in the ear canal is a common problem that can cause discomfort or prevent assessment. Cerumen removal can have deleterious side effects if performed improperly. We created an aural irrigation system which is currently not available on the market to provide a continuous flow of water at a regulated pressure and temperature. The purposes of this study were to (1) evaluate the safety and efficacy of this aural irrigation system in children and (2) determine the success rate of cerumen disimpaction when used by an allied health professional. Methods: The following were evaluated in a nurse-run clinic: (1) referral patterns; (2) extent of canal occlusion; (3) cerumen consistency; (4) peak water pressure used; (5) patient discomfort; (6) efficacy of removal. Each ear was recorded as a separate event. Results: 302 procedures were performed on 244 children (mean age 7.6 ± 4.1 years (range 0.5-18.3 years)). Patients were most commonly referred by an Otolaryngologist (63%), parent (17%), hearing aid provider (10%) or audiologist (9%). The most common reasons for referral were difficulty seeing the tympanic membrane (42%), fitting a hearing aid (20%) or performing an audiogram (11%). Prior to irrigation, 98% of canals were partially or fully occluded. After irrigation (mean peak pressure=488.21 ± 18.61 mm Hg (range 390-590 mm Hg), 92% of canals were completely free of cerumen (99% clear enough for evaluation or treatment). There was mild or no discomfort in 99% of patients and there were no incidences of trauma. Conclusions: An aural irrigation system can be effective at clearing impacted cerumen from pediatric ear canals with minimal discomfort and no trauma and can be successfully employed in a completely nurse-run clinic.
Objective: This guideline provides evidence-based recommendations on managing cerumen impaction, defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. We recognize that the term "impaction" suggests that the ear canal is completely obstructed with cerumen and that our definition of cerumen impaction does not require a complete obstruction. However, cerumen impaction is the preferred term since it is consistently used in clinical practice and in the published literature to describe symptomatic cerumen or cerumen that prevents assessment of the ear. This guideline is intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction. Purpose: The primary purpose of this guideline is to improve diagnostic accuracy for cerumen impaction, promote appropriate intervention in patients with cerumen impaction, highlight the need for evaluation and intervention in special populations, promote appropriate therapeutic options with outcomes assessment, and improve counseling and education for prevention of cerumen impaction. In creating this guideline the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of audiology, family medicine, geriatrics, internal medicine, nursing, otolaryngology-head and neck surgery, and pediatrics. Results: The panel made a strong recommendation that 1) clinicians should treat cerumen impaction that causes symptoms expressed by the patient or prevents clinical examination when warranted. The panel made recommendations that 1) clinicians should diagnose cerumen impaction when an accumulation of cerumen is associated with symptoms, or prevents needed assessment of the ear (the external auditory canal or tympanic membrane), or both; 2) clinicians should assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as one or more of the following: nonintact tympanic membrane, ear canal stenosis, exostoses, diabetes mellitus, immunocompromised state, or anticoagulant therapy; 3) the clinician should examine patients with hearing aids for the presence of cerumen impaction during a healthcare encounter (examination more frequently than every three months, however, is not deemed necessary); 4) clinicians should treat the patient with cerumen impaction with an appropriate intervention, which may include one or more of the following: cerumenolytic agents, irrigation, or manual removal other than irrigation; and 5) clinicians should assess patients at the conclusion of in-office treatment of cerumen impaction and document the resolution of impaction. If the impaction is not resolved, the clinician should prescribe additional treatment. If full or partial symptoms persist despite resolution of impaction, alternative diagnoses should be considered. The panel offered as an option that 1) clinicians may observe patients with nonimpacted cerumen that is asymptomatic and does not prevent the clinician from adequately assessing the patient when an evaluation is needed; 2) clinicians may distinguish and promptly evaluate the need for intervention in the patient who may not be able to express symptoms but presents with cerumen obstructing the ear canal; 3) the clinician may treat the patient with cerumen impaction with cerumenolytic agents, irrigation, or manual removal other than irrigation; and 4) clinicians may educate/counsel patients with cerumen impaction/excessive cerumen regarding control measures. Disclaimer: This clinical practice guideline is not intended as a sole source of guidance in managing cerumen impaction. Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. It is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.
Wax removal compromises the integrity of the ear's defenses. It is a leading cause of otitis externa, Otomycosis and impaired hearing. Aims of the study are to assess the knowledge and implication of self ear cleaning among black Africans. A prospective study carried out at the Tundun-wada community and National Ear Care Centre, Kaduna with administration of structured questionnaire after an informed consent and ethical clearance. Information retrieved includes biodata, believe, reason and object for cleaning of the ear, associated problems or benefit and examination. A total of 372 form the basis for the study, age range 1-76 yr with a mean age of 30.37 yr, median age 29.00 (S.D. = 13.79) and M:F ratio of 1:1. Mother responded for their children except for grown up. About 47.3% of the subjects were unemployed who were either children or complete house wife. About 90% of the subjects interviewed do self ear cleaning and over 90% believe ear should be cleaned to remove wax, because of itching in over 50% while a few is due to cosmetic reason. Cotton bud was the commonest material used for cleaning. About one-third of the subject has formed the habit unconsciously over 10 years. The entire subjects interviewed had their ear examined; about 27% had ear discharge then wax impaction in 22% then foreign body 12%. The habit of self ear cleaning should be discouraged as it is slow otologic poison with an attendant long term effect.
At KGMC Lucknow, 168 pediatric cases with aural foreign bodies (FB) were reviewed. Most of the FB were self-inflicted and seen in children under 5 years of age (69.64%), within 24 hours (91.66%) of impaction. 86.30% of FB were seen to impact in external auditory canal (EAC) and their nature revealed predominance of nonvegetative inanimate FBs (43.45%). The TM perforation was encountered in only 6.54% of cases. If the FB is a living insect, it should be drowned before being manipulated. Syringing is the method of choice for a nonimpacted relatively small FB, even if it is vegetative. It is to be avoided in the 'potential' cases of external otitis or in cases with severely impacted wax. For a tightly wedged smooth rounded FB the hook and forceps are preferred in superficially and deep lying FBs respectively. A dissociate anaesthesia (ketamine) appears to be a better choice than general anaesthesia. An end-aural incision should be preferred over post-aural one and canalplasty for access of FB should be carried out wherever necessary. The presence of otorrhoea in cases of penetrating FB or aural myasis should be dealt on the lines of otitis media after removing the FB concerned.
A 7-year-old boy had a right-sided tympanoplasty for attical cholesteatoma in 1998. He had no postoperative complications or recurrence. A year later, he complained of a persistent dry cough that was present both day and night. Over the next 7 years, he had many investigations of the upper and lower respiratory tracts, including serial chest radiographs, computed tomography of the sinuses, bronchoscopy, nasofibroscopy, and allergy screening. He also had cerebral computed tomography and a psychological evaluation to exclude a psychogenic origin for his cough. None of these tests were sufficient to
Otitis externa (OE), also known as "swimmer's ear", is an inflammation or infection of the external auditory canal. Many risk factors have been identified, mainly excessive moisture in the canal from swimming. To study the leading risk factors of otitis externa. Eighty-seven children aged 3.5-12 years (mean 68+/-6.5 months) who were diagnosed with otitis externa from December 1999 to March 2001 were studied for age, sex, cerumen cleaning habits, signs and symptoms. Findings were compared to an age-matched control group of 90 children without otitis externa. Sixty-one children (70.1%) in the study group had their ears cleaned with a cotton-tip applicator (Q-tip) during the 10 days preceding the diagnosis of otitis externa. In the control group, only 31 (34%) used applicators routinely during the 10 days prior to diagnosis (P<0.001). Other risk factors for otitis externa were swimming in a pool (34%), wax removal (5.8%) and ventilation tubes (1.1%). Use of a cotton-tip applicator to clean the ear seems to be the leading cause of otitis externa in children and should be avoided.