Impacted cerumen. (Otoscopic Clinic).

This otoscopic view of a right ear shows a large, dark-brown mass of hard cerumen completely occluding the external auditory canal. The mass is visible at the bony cartilaginous junction of the external auditory canal. The hard cerumen contains hairs, which act as a reinforcement of the cerumen. Impacted cerumen is a common cause of temporary hearing loss, tinnitus, and ear fullness. The etiology is unknown. Many methods are available to remove impacted cerumen. The consistency of the cerumen determines which technique will work best. A hard mass, as demonstrated in this photograph, is usually best removed with a ring curet and the use of the operating microscope. A softer, more liquid type of cerumen is usually best removed by irrigating the ear with water at body temperature. Difficult-to-remove cerumen can sometimes be softened by instilling an edible oil or mineral oil for several days. In cases in which the impacted cerumen produces otalgia, the ear canal can first be anesthetized with an injection of a local anesthetic and then painlessly removed in a surgical manner with the use of the operating microscope. A lytic agent such as Cerumenex can be used for several days to liquefy difficult-to-remove cerumen.

From Gap, France (Dr. Deguine), and the Pulec Ear Clinic, Los Angeles (Dr. Pulec).