within the canal. Cerumen is usually yellowish
brown in color and its presence is normal, though
many people attempt to clean it from the ears for
aesthetic reasons. Most health experts recommend
against using cotton swabs within the auditory
canal for this purpose; it is possible for the swab to
compact the cerumen, push foreign objects deeper
into the ear, or damage the TYMPANIC MEMBRANE
(eardrum). Tightly compacted cerumen can block
sound waves from traveling through the auditory
canal, interfering with hearing, and create
unequal pressure, causing balance disturbances. It
also can trap water in the auditory canal, allowing
fungal or bacterial INFECTIONto develop. Softening
drops help loosen compacted cerumen so the ear’s
natural mechanisms can push it out of the audi-
tory canal. When this does not work, removal
may require a health-care provider to perform EAR
LAVAGEor other techniques.
For further discussion of cerumen within the
context of otolaryngologic structure and function,
please see the overview section “The Ear, Nose,
Mouth, and Throat.”
See also CLEANING THE EAR; FOREIGN OBJECTS IN THE
EAR OR NOSE.
cholesteatoma A growth that develops within
the middle EAR. Most cholesteatomas develop as a
consequence of frequent middle ear infections (OTI-
TISmedia) or chronically blocked eustachian tubes,
such as by frequent SINUSITIS(sinus infection) or
ALLERGIC RHINITIS. A cholesteatoma starts as an out-
pouching of SKINon or near the TYMPANIC MEMBRANE
(eardrum). SKINcells accumulate inside the pouch,
causing it to enlarge and exert pressure against the
tympanic membrane and auditory ossicles (tiny
bones of the middle ear). Over time the increased
pressure can destroy the auditory ossicles, causing
HEARING LOSS. A large cholesteatoma can also exert
pressure inward against the inner ear, causing VER-
TIGOand balance disturbances.
Symptoms of cholesteatoma include the sensa-
tion of fullness in the affected ear, diminished
hearing, dizziness and vertigo if there is pressure
against the inner ear, and aching or dull PAIN
behind the ear. Symptoms are often positional and
may worsen at night, especially pain. Some people
experience a puslike drainage, often apparent on
the pillow. The diagnostic path may include X-
rays, COMPUTED TOMOGRAPHY(CT) SCAN, and MAG-
NETIC RESONANCE IMAGING(MRI) of the head. Treat-
ment requires overcoming any INFECTION with
ANTIBIOTIC MEDICATIONSand sometimes surgery to
remove the cholesteatoma and clean the area.
Treatment often restores hearing, though when
the cholesteatoma is large or has been present for
a long time the otolaryngologist may be unable to
repair the damage to the middle ear. Damage that
occurs within the inner ear often is permanent.
Prompt treatment of sinusitis or otitis minimizes
the risk for cholesteatomas to develop, though
these growths are not preventable. Early diagnosis
and treatment of cholesteatoma offers the best
opportunity to prevent permanent hearing loss
and vestibular (inner ear) dysfunction. Untreated
cholesteatoma can result in profound hearing loss
in the affected ear as well as MASTOIDITIS and
MENINGITIS.
See also ACOUSTIC NEUROMA; TYMPANOPLASTY; X-RAY.cleaning the ear Hygienic measures to keep the
ears clear of debris. For the most part, the ears are
self-cleaning. Tiny hairs (cilia) line the inside of
the auditory canal, moving in wavelike motions to
sweep particles of dust and pollen, as well as
sloughed SKINcells, to the outer edge of the EAR.
CERUMEN, or ear wax, helps collect these particles
for easy removal. Most people need only to wash
the outer ear during regular bathing to remove
any accumulations of cerumen and debris. How-
ever, many people feel the need to wipe the inside
of the auditory canal with cotton swabs. Most
health-care providers recommend against this.
Persistent swabbing of the auditory canal can lead
to compacted or impacted cerumen that blocks the
canal, interfering with hearing as well as prevent-
ing the ear’s normal cleansing mechanisms from
functioning. It also is possible for pieces of the cot-
ton swabbing to come off inside the canal, creating
obstructions, and to perforate the TYMPANIC MEM-
BRANEwith the tip of the swab. A doctor should
evaluate any concerns about excess cerumen or
foreign objects in the ear. A health-care provider
can perform EAR LAVAGEwhen additional cleaning
is necessary. A popular admonition among oto-
laryngologists is, “Never put anything smaller than
an elbow into the ear.”
See also FOREIGN OBJECTS IN THE EAR OR NOSE.cleaning the ear 15