[STUDIES ON THE CHEMICAL COMPOSITION OF HUMAN NORMAL CERUMEN. 3. ON THE FREE AMINO ACID CONTENTS OF CERUMEN WITH SOME DATA ON THE PEPTIDE-X].
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Amino Acids↗
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Micro-chemical studies on normal cerumen. I. The lipid and protein content of normal cerumen as affected by age and sex.
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Aging↗
Micro-chemical studies on normal cerumen. II. The percentage of lipid and protein in casual and fresh cerumen.
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Apocrine Glands↗
Cerumen, hearing, and cognition in the elderly.
OBJECTIVE: This investigation was performed to study the prevalence of cerumen impaction and evaluate its impact on hearing and cognition in elderly patients admitted to a skilled nursing facility (SNF). DESIGN: Prospective clinical trial using a pretest-posttest design. SETTING: A 160-bed skilled nursing facility. SUBJECTS: Twenty-nine English-speaking residents over the age of 65 who were new admissions to a SNF. INTERVENTION: Participants with cerumen that occluded 50% or more of the external auditory canal had cerumen removed with a cerumenolytic agent and tepid water irrigation. MEASUREMENTS: A standardized Folstein Mini-Mental Status Exam (MMSE)(1) and audiometric evaluation were administered to all participants before and after cerumen removal. Participants who did not have cerumen impaction served as controls. Hearing changes were scored as "+1" for an improvement, "0" for no change and "-1" for a loss at each frequency tested. Results were compared using 2-tailed paired t tests. RESULTS: Nineteen participants (65.5%) had cerumen in at least one ear. Following cerumen removal, hearing improved in 80% of impacted ears compared with 3% of nonimpacted ears (P < 0.001). The average change in hearing score following cerumen removal was 0.26 +/- 0.50 compared with an average change of 0 +/- 0.16 in the controls (P < 0.001). The average change in MMSE score was 1.05 +/- 1.6 for participants who had cerumen removed compared with -0.30 +/- 0.95 for the controls (P < 0.01). CONCLUSIONS: This study found a majority of residents admitted to the SNF had cerumen impaction. Evaluation of hearing and mental status following removal of cerumen resulted in a statistically significant improvement in hearing and cognition when compared with controls. Removal of cerumen is a relatively safe and easy procedure that can be done at minimal cost and provide a significant benefit to residents of a SNF.
Journal Article↗
Effect of cerumen removal on the hearing ability of geriatric patients.
The purposes of this study were to estimate the prevalence of impacted cerumen in a population of hospitalized elderly patients, and to evaluate the effect of cerumen removal in reversing hearing impairment. The design was a pre-test/post-test static-group comparison. Over a 1-year period, a random sample (n = 226) was drawn every third day from daily admission lists of English-speaking patients aged 65 or older, admitted to non-intensive care units of one hospital. On either the second or third day of hospital stay, subjects were given a hearing test using an AudioScope and then their ear canals were examined for impacted cerumen. Ear canal irrigations were performed on those subjects with impacted cerumen. All subjects received a second hearing test. Results indicate that impacted cerumen is a common condition in the hospitalized elderly. Thirty-five per cent of the sample had impacted cerumen, 19.9% bilaterally and 15.0% unilaterally. Furthermore, removal of cerumen significantly improved hearing ability. Improved hearing scores were obtained in 75.0% of the ears after the impacted cerumen was removed, with subjects hearing from one to three more tones per ear on the second hearing test. An analysis of variance for repeated measures on hearing was computed to test for the effect of removing cerumen from individuals who had neither, one or both ears occluded. A significant interaction (F = 146.83, d.f. = 2/223, P less than 0.0001) between hearing tests and cerumen removal was found indicating that those with no occlusion had no change in hearing whereas both occluded groups increased with the greatest change for the bilateral group.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Does cerumen have a risk for transmission of hepatitis B?
OBJECTIVES/HYPOTHESIS: Chronic hepatitis B virus infection is a significant worldwide health problem. It affects 350 to 400 million people. The patients with chronic hepatitis B virus infection have a significant risk for the development of cirrhosis or hepatocellular carcinoma. Full awareness of the mechanisms of transmission can allows susceptible individuals to refrain from this infection. Cerumen has never been studied as a route for hepatitis B transmission. The aim of the study was evaluate the importance of cerumen in transmission of hepatitis B virus infection. STUDY DESIGN: This study was performed on forty patients with confirmed hepatitis B virus infection. METHODS: Forty cerumen specimens collected from the patients with hepatitis B virus DNA in their sera were prospectively analyzed for the presence of hepatitis B virus DNA by real-time polymerase chain reaction. RESULTS: Eleven of 40 cerumen specimens (27.5%) were positive for hepatitis B virus DNA, with counts ranging from 4.2 x 10 to 4.7 x 10 copies per sample. There was positive correlation between hepatitis B virus DNA concentrations of serum and cerumen. Half of hepatitis B e antigen (HBeAg)-positive patients had detectable hepatitis B virus DNA levels (5.7 x 10 to 4.7 x 10 copies) in cerumen specimens, whereas 12.5% of cerumen specimens from anti-HBe-positive patients had hepatitis B virus DNA levels (4.2 x 10 to 7.0 x 10 copies). CONCLUSION: Cerumen can be a potential source of transmission. Therefore, this route should be investigated in further studies for horizontal, nosocomial, and occupational transmission of hepatitis B.
Adolescent↗
Impacted cerumen: a disorder of keratinocyte separation in the superficial external ear canal?
In the majority of individuals, impaction of cerumen in the external auditory canal does not occur, and it is only a fraction of the population who regularly need to consult their physician for aural toilet. In this study we looked at the clinical features associated with recurrent cerumen impaction in 20 individuals. This was complemented by an examination of the cerumen plugs taken from their ears and hydrated to analyze the morphology of the keratin sheets, which had been observed in a previous study to constitute over one-half of the volume of impacted cerumen. In a further eight patients with cerumen, impaction plugs of cerumen were removed and subjected to histological examination. We observed that excessively long sheets of undivided keratin could be isolated from the hydrated cerumen plugs and that these sheets of keratin morphologically resembled the superficial layers of the stratum corneum of normal human deep external auditory canal skin. Based on these observations, we propose that cerumen impaction is the result of a failure in the normal keratinocyte separation which occurs in the superficial external auditory canal.
Cerumen↗
Cerumen removal. How necessary is it to diagnose acute otitis media?
We evaluated the consistency and appearance of aural cerumen and the degree to which such cerumen obscured the view of the eardrum in 279 children with unilateral acute otitis media with effusion (AOME). Mechanical removal of cerumen was necessary overall in 29% of the patients. Cerumen removal was inversely proportional to age, and we found it necessary to remove such cerumen to visualize most of the eardrum in 35 (57%) of 61 infants with AOME. Some physicians believe that the heat generated from an intensely inflamed middle ear will invariably cause sticky, honey-colored cerumen to liquefy. Only 29 children (11%) in this study had aural cerumen with a soft cheesy or semiliquefied consistency.
Cerumen↗
Influence of human wet cerumen on the growth of common and pathogenic bacteria of the ear.
The available data on the effect of human wet cerumen on bacterial growth are not conclusive. Nevertheless it is widely accepted that cerumen has a bactericidal effect. In this study the activity of human wet cerumen on bacterial growth was assessed by applying cerumen suspensions to bacterial cultures. Bacterial counts were performed before and after application of cerumen suspensions. A total of 383 assays was carried out with 73 pools of cerumen that were tested against cultures of Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium spp., Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa and Serratia marcescens. An increase in growth occurred much more frequently than a decrease in growth in almost every microrganism tested, with the mean increase percentage being much higher than the mean decrease percentage, except in the case of S. aureus. The largest average growth increase was obtained with E. coli. The largest average decrease in bacterial growth was recorded with S. marcescens. Our study does not support the conception of a decrease in bacterial growth produced by humen wet cerumen. In vitro, the most observable effect was in fact an increase in microbial growth.
Adolescent↗
Cerumen phenotype and proliferative epithelium in breast fluids of U.S.-born vs. immigrant Asian women: a possible genetic-environmental interaction.
To determine whether a genetic-environmental interaction exists between the breast, a modified apocrine gland, its secretions, and the genetic polymorphic phenotypes of wet and dry cerumen, we examined nipple aspirate fluid (NAF) for proliferative disease in 172 U.S.-born and immigrant Chinese and Japanese women. Cytologic evidence of proliferative epithelial cells (benign hyperplasia and/or atypical hyperplasia) was found in the NAF of 36 women (20.9%). A significantly higher incidence of proliferative epithelial cells was present in the NAF of U.S.-born than in immigrant Asian women (28.6% vs. 16.5%) (p = 0.05). A higher proportion of U.S.-born Asian women with wet cerumen than women with dry cerumen had proliferative epithelial cells in NAF: 39.3% vs. 20.0% (p = 0.08). No significant difference in NAF proliferative cells was found between immigrant women with wet and dry cerumen: 15.8% vs. 17.3%; p = 0.50. A strong association of proliferative epithelial cells and cerumen phenotype was found in parous U.S.-born women (wet = 47.6% vs. dry = 16.0%; p = 0.002). No significant association with wet and dry cerumen phenotype was found in parous immigrant women (wet = 12.2% vs. dry = 20%). These findings support the hypothesis that an apocrine genetic polymorphic trait differentially influences susceptibility of the breast to proliferative disease in Asian women born in environments presumed to be of high risk for breast cancer compared to women from low risk environments.
Body Fluids↗
Study of common aerobic flora of human cerumen.
Cerumen is the product of the secretion of the sebaceous, ceruminous or apocrine glands together with cells exfoliated from the cornified stratum of the epithelium of the external auditory canal (EAC). In the present study we identified and quantified common flora of human cerumen. The mean count obtained was 10(6) microorganisms per ml of cerumen suspension. In 24 pools of cerumen (33.3 per cent) the isolates were monomicrobial, Staphylococcus epidermidis (12), Corynebacterium spp (10), Staphylococcus aureus (1) and Streptococcus saprophyticum (1). In 48 pools (66.6 per cent) we found polymicrobial isolates. The most commonly isolated bacteria in these polymicrobial isolates were S. epidermidis (35) and Corynebacterium spp. (43). It is noteworthy that there were isolates of Candida albicans in three cases; in one case of Pseudomonas stutzeri, in one case of Pseudomonas aeruginosa, and, on seven occasions, of S. aureus. The organisms isolated as common bacterial components of human cerumen in our experience were similar to those found by other authors. However, the mean count was much higher. This could be related to climatic conditions and to the length of time the cerumen had remained in the external auditory canal.
Adolescent↗
[Cerumen from the anthropologic viewpoint].
The dimorphism of cerumen was first discovered by Kishi in 1907. There are two types of cerumen which differ in colour and consistency: the flocky and gray dry cerumen and the sticky yellow to brown wet cerumen. The comprehensive review of the frequency of the different cerumen types and their geographical distribution result in evidence for the dry type as a distinguishing feature of the mongoloid peoples (including the American Indians). The frequency of the wet cerumen prevails significantly in the Negroid (Congoid) and the Europoid (Caucasoid) population. Intermediate incidence data are due to racial intermixture.
Cerumen↗
Impacted cerumen: composition, production, epidemiology and management.
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.
Cerumen↗
Cerumen-impaction management for clients of all ages.
A cerumen plug in the external auditory canal can cause dizziness, pain, itching, ringing or decreased hearing. These symptoms are particularly distressing to elderly clients who may already have compromised hearing or be experiencing changes in functional ability. A cerumen plug that causes hearing impairments can retard children's educational and psychosocial development. This article focuses on the physiology of cerumen, the risk factors of cerumen plugs and the best way to remove cerumen in clients of all ages. The contraindications and complications of aural lavaging and instrument removal of cerumen are discussed. An ear-irrigation flow sheet is also included for ambulatory clinical use.
Cerumen↗
Bactericidal activity of wet cerumen.
The viable populations of seven species of bacteria were reduced 17% to 99% by treatment with a 3% suspension of human cerumen of the soft or "wet" type. Species tested for susceptibility to cerumen were Staphylococcus aureus, Staphlylococcus epidermidis, Streptococcus pyogenes, Propionibacterium acnes, Corynebacterium spp, Escherichia coli, and Serratia marcescens. The reduction depended upon the species of bacterium and the age of the culture. Pathogenic species appeared to be more susceptible than others, while cultures in logarithmic growth were more susceptible than stationary phase cultures to the bactericidal activity of wet cerumen. There appeared to be little difference in the bactericidal activity between the two lots of cerumen used. The bactericidal activity of wet cerumen was found to be quite similar to that of dry cerumen as reported earlier in the literature.
Bacteria↗
Hearing impairment in children with impacted cerumen.
The aim of this study was to determine whether children in whom impacted cerumen had been removed were at greater risk of hearing impairment than those without a history of impacted cerumen. A retrospective study was conducted in 113 subjects and their pair-matched controls taken from a population of 359 randomly selected school entrants who received otoscopic, audiometric and tympanometric evaluations. It was found that children from whom impacted cerumen had been removed were more likely to have hearing loss (p = 0.0001), and of a more permanent nature (p = 0.002). They were also likely to have more otitis media with effusion (OME) (p = 0.045). Children with a history of impacted cerumen are therefore at greater risk of subsequent hearing problems and of a more permanent nature than those without, notwithstanding the removal of such impacted cerumen. The prevention of cerumen impaction should be of significant public health concern in the management of hearing impairment in children, especially where there is no routine and systematic screening for hearing disorders.
Audiometry, Pure-Tone↗
Chronic tinnitus resulting from cerumen removal procedures.
This study was undertaken to determine how many cases of chronic tinnitus in a clinic population resulted from cerumen removal procedures and to summarize cerumen management methodologies and recommendations that will reduce the likelihood of such serious complications. Detailed questionnaires were mailed to 2400 consecutive patients (1704 male, 696 female; mean age, 53.3 +/- 11.8 years; age range, 7-87 years) prior to their initial appointment at the Oregon Health & Science University Tinnitus Clinic between 1986 and 2000. These questionnaires requested information about patients' medical, hearing, and tinnitus histories. Records were analyzed to determine how many patients reported that their chronic tinnitus began as a result of cerumen removal procedures. Of 2400 patients, 11 (0.46%) reported that their tinnitus began as a result of cerumen removal procedures performed by clinicians. Three additional patients reported that chronic tinnitus began as a result of their own attempts to clean their ear canals. Chronic and debilitating conditions, such as hearing loss and tinnitus, can occur as results of attempts to remove cerumen. By following the recommendations of experts in cerumen management techniques, clinicians can reduce the likelihood of catastrophic complications and subsequent litigation.
Adolescent↗
Incidence of excessive/impacted cerumen in individuals with mental retardation: a longitudinal investigation.
A major sequelae of impacted cerumen (earwax) is conductive hearing loss, which can be deleterious to linguistic, social, and intellectual development, particularly for individuals with mental retardation. The longitudinal incidence (12-year period) of excessive/impacted cerumen and related conductive hearing loss of 117 adults with mental retardation was examined. Results indicated a considerably higher incidence of excessive cerumen and cerumen impaction with associated conductive hearing loss in adults with mental retardation (28%) than in the general adult population (2% to 6%). Moreover, a strong propensity for recurrent cerumen impaction in the mentally retarded population was found. These findings were discussed in view of the management of cerumen impaction among individuals with mental retardation.
Adult↗