Posted: 4/21/2013 4:34:30 AM EDT
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So a few days ago I started getting heavy wax in my right ear, attempts to clear it failed, and I think I just impacted it. Then a started getting mild pain in that ear, and partial hearing loss depending how I tilted my head, or if anything pressed, on, or near my ear (kind of like if I put an ear plug in). I figured it was the wax, so I gave it a couple days to clear, it didn't. So I got some Debrox, the kind with the ear syringe. I put about 10 drops in my ear, and sat with my head cocked to the side for maybe 10 minutes, and listened to it fizz, and felt it tickle. Then I tried the ear syringe to blast the wax out without success, now it hurts slightly more than last might, I feel what I can only describe as pressure under my ear, and I can even kind of, sort of feel it in my jaw when I close my mouth all the way, but the "ear plug" feeling is gone, and I can hear much better if slightly deadened, and a tiny amount of ear wax actually drained out. It's not the same steady pain/throbbing of a few hours ago, but I still get the occasional throb, and I have more pressure than before, and there is the occasional tickle.
Should I just keep using the Debrox, and syringe, try something else, or do I need to go to the doctor, have my ear shop vaced, and get on antibiotics? I've heard to keep water away from ear infections, yet the instructions for the Debrox say to use water with the ear syringe, which is right? If I don't, how long before this clears up on it's own? |
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I'd flush it some more with lukewarm water.
You have to remember the anatomy: Unless your ear drum is rupture, there is no connection between the ear canal and the inner ear. If there is an infection, it is either on the ear canal side of the ear drum or on the inner side of the ear drum. An ear infection is not going to clear with what you've done so my bet is that you're correct on the wax being the problem. That stuff can be tenacious. ETA: Quoted:
I've heard to keep water away from ear infections, yet the instructions for the Debrox say to use water with the ear syringe, which is right? There are internal ear infections and external ear infections. The latter occur in the ear canal itself, whereas the former are on the other side of the ear drum (tympanic membrane). Are you having any fever, chills? Have you had any other symptoms of a recent upper respiratory infection? If not, then you're likely dealing with wax. |
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I know how everyone loves these. Link
Seriously go to a doctor. Don't wait. |
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Can't do anything until at least tomorrow. I won't pay the $800 to go to the Emergency Room, Doctors not open today, and no cash on hand for Urgent Care until at least tomorrow. Besides which thanks to a moron that doesn't know what turn signals are for I'm without a functioning car now, and would need to arrange for a ride.
This is why I was hoping to avoid a trip to the doctor. |
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Meh. They don't necessarily treat otits media in children in Europe with antibiotics. The question is: Is this otits media or otitis externa? If you have drainage, then it is either otits externa or you have a perforated TM. Do you have diabetes? Are you a swimmer, or spend time in the water? Both of these increase the risk for otits externa. OTITS MEDIA: CLINICAL MANIFESTATIONS OF AOM — The onset of AOM in adults is typically associated with otalgia (ear pain) and decreased hearing. Fever may not be present. A preceding upper respiratory tract infection or exacerbation of seasonal allergic rhinitis may herald the onset of AOM by several days. There is considerable variability in the symptoms and signs of AOM. The infection is typically but not always unilateral. A bulging tympanic membrane distinguishes acute otitis media from otitis media with effusion. (picture 1). The tympanic membrane may also be erythematous or opacified. If the tympanic membrane has ruptured (often reported by the patient as a relief of the otalgia), there may also be associated purulent otorrhea. TREATMENT OF AOM — Antibiotics are the mainstay of treatment of uncomplicated suppurative acute otitis media in adults. Consistent results from bacteriologic studies of middle ear effusions in children and adults with AOM suggest that the choice of antimicrobial agents may be based on knowledge of the bacteriology of AOM, rather than results of cultures from adjacent sites such as the throat or nasopharynx. Microbiologic results indicate that at least one-quarter of children have AOM due to a viral respiratory pathogen, and that some of the episodes of AOM resolve without antibacterial agents. Among children with AOM, approximately 19 percent of pneumococcal, and up to one-half of H. influenzae AOM cases resolve and fluid samples from the middle ear become sterile without antibacterial drugs [34,35]. These results prompted some European clinicians to withhold antibiotic therapy from children with ear infections [36]. The option of observation of children with AOM, rather than initial antimicrobial therapy, is practiced extensively in Western Europe. In 2004 the American Academy of Pediatrics and the American Academy of Family Physicians proposed a similar protocol for withholding antimicrobial therapy for children who were older than two years of age, whose diagnosis was uncertain, and who did not have severe disease (eg, moderate to severe otalgia with fever ≥39°C) [37]. There are no data about withholding antimicrobial drugs from adult patients with AOM. At this time, it is prudent to treat adults with antibiotic therapy for a diagnosis of AOM to prevent the potential for complications of an untreated infection. (See 'Complications of AOM' below.) While awaiting response to antibiotic therapy, it is important to address the relief of pain, which can be significant. Most patients will symptomatically improve with a mild analgesic, such as a nonsteroidal antiinflammatory medication, although a short course of opioids is occasionally indicated. OTITS EXTERNA: CLINICAL FEATURES — The most common symptoms of external otitis are ear pain, pruritus, discharge, and hearing loss [2]. In addition to symptoms, patients should be asked about any known tympanic membrane perforation, previous ear infections, any prior ear surgery, recent ear instrumentation, and water exposure. On physical examination, the auricle and tragus should be examined for erythema or signs of trauma (figure 1). Tenderness with tragal pressure or when the auricle is manipulated or pulled are indicative findings of external otitis. However, these signs may be absent in mild cases. Otoscopy is critical for distinguishing between external otitis, otitis media, and other ear pathology. The ear canal usually appears edematous and erythematous in external otitis. Debris or cerumen is typically yellow, brown, white, or gray. Otomycosis, a fungal infection of the external canal, may take on different appearances (eg, fine, dark coating with Aspergillus; white, sebaceous-like material with Candida). (See 'Otomycosis'below.) The tympanic membrane may be erythematous in external otitis and only partially visible due to canal edema. The presence of an air-fluid level along the tympanic membrane is indicative of a middle ear effusion and underlying otitis media (picture 1). CLEANING THE EAR CANAL — Cleaning out the external canal (aural toilet) is the first step in treatment. The removal of cerumen, desquamated skin, and purulent material from the ear canal greatly facilitates healing and enhances penetration of ear drops into the site of inflammation [1]. Ear canal cleaning should be performed through an otoscope that allows direct visualization and use of a wire loop or cotton swab to gently remove debris and cerumen. The ear canal may be irrigated with a 1:1 dilution of 3% hydrogen peroxide at body temperature if the tympanic membrane is visible and intact. Patients with a ruptured tympanic membrane (or those in whom the tympanic membrane cannot be clearly seen) should be referred to an otolaryngologist for further management. Otolaryngologists often clean infected ears under a microscope; this provides binocular magnified vision and liberates both hands. The ability to use both hands with magnified vision may also facilitate cleaning when the ear is extremely tender. (See "Evaluation and management of middle ear trauma" and "Evaluation of earache in children", section on 'Traumatic tympanic membrane (TM) perforation' and "Acute otitis media in adults (suppurative and serous)", section on 'Ruptured tympanic membrane'.) TREATMENT OF INFLAMMATION AND INFECTION — Treatment of inflammation and infection primarily involves use of topical agents. Systemic antibiotics are indicated in patients with deep tissue infection (outside the external canal) and immunocompromised hosts. Topical therapy — Topical therapy is highly effective for external otitis, delivering a high concentration of medication to the infected and inflamed tissue with minimal side effects [1,2]. Topical preparations — Several topical agents are available for treating external otitis, including antibiotics, antiseptics, glucocorticoids, and acidifying solutions [1]. They are administered as single agents and combination formulas (table 1). Most are used in a liquid form, although ointments and powders are also available. Antibiotics — Topical antibiotics are highly effective for treating external otitis [3]. One systematic review found that topical antibiotics increased absolute clinical cure rate compared to placebo by 46 percent (95% CI 29-63 percent) [2]. The review also found no significant difference comparing topical antibiotics to antiseptics, or to combination antibiotic/glucocorticoid preparations. There was also no difference in cure rates between quinolone and nonquinolone antibiotics. Certain factors should be considered when selecting an ototopical antibiotic: coverage of specific pathogens (table 2A-B), side effect profile (including ototoxicity and contact dermatitis), and drug resistance. The ideal antibiotic regimen should have specific coverage against the most common pathogens, P. aeruginosa and S. aureus:
Side effect profile can also influence choice of treatment. Ototoxicity is the most important concern with aminoglycoside agents, including neomycin, tobramycin, and gentamicin [7]. Aminoglycosides are a significant potential source for iatrogenic hearing loss and balance dysfunction, particularly in the presence of tympanic membrane perforation. Allergic contact dermatitis is commonly associated with neomycin when used for prolonged courses [8]. Topical fluoroquinolones can cause local irritation. (See "External otitis: Pathogenesis, clinical features, and diagnosis", section on 'Contact dermatitis'.) Concerns have been raised about the development of antibiotic resistance, particularly against P. aeruginosa with chronic use of ototopical fluoroquinolones. However, in vitro, P. aeruginosa sensitivity to norfloxacin remained high (98 percent) in one study despite long-term antibiotic use [9]. Drug resistance may be important in the setting of treatment failure, requiring culture of the ear canal. (See 'Follow-up' below.) Antiseptics — Antiseptics function as bacteriostatic agents, not as bacteriocidal agents like antibiotics. Their precise mechanism of action is not fully understood, but they make the ear canal less habitable for bacteria and may loosen debris in the ear canal. Systemic reviews and meta-analyses, albeit of low-quality trials, suggest that these agents are similarly effective as other topical agents [1,2]. Available antiseptics are listed in a table (table 1). Alcohol is the most commonly used antiseptic component of many ototopical preparations. Glucocorticoids — Topical glucocorticoids decrease inflammation, resulting in relief of pruritus and decreased pain. Glucocorticoids used to treat external otitis include hydrocortisone, dexamethasone, and prednisolone (table 1) [1]. These topical agents are well-tolerated. A meta-analysis of randomized trials, which included three studies comparing antimicrobial/glucocorticoid versus antimicrobial alone, found comparable clinical and bacteriologic cure rates at seven days for regimens with and without glucocorticoids [2]. The addition of a hydrocortisone to either acetic acid or ciprofloxacin, however, did decrease time to symptom resolution by one day. Acidifying solutions — P. aeruginosa and S. aureus readily grow in environments with a pH of 6 to 7, but grow less well at a lower pH [10]. Thus, simply acidifying the ear canal inhibits bacterial growth. Commonly used acidifying solutions are acetic acid, boric acid, hydrochloric acid, and sulfuric acid (table 1). Acidifying solutions are generally safe, but may be associated with local irritation manifested by burning or stinging. In the presence of tympanic membrane perforation, acidifying solutions can be particularly irritating to the mucosa of the middle ear. One meta-analysis found no clinically meaningful differences between acidifying agents and other topical interventions [1]. However, there was one trial of high quality that found acetic acid was less effective than acetic acid plus glucocorticoid and antibiotic plus glucocorticoid drops at two and three week follow-up [11]. Combination therapy — Several combinations of the above topical agents are available in clinical practice (table 1). The efficacy of several different combination preparations have been examined in meta-analyses of randomized trials, with no specific combination therapy superior over other therapy [1]. Choice of topical agent — Choosing the proper ototopical agent or combination of agents is difficult given the wide array of choices (table 1). The choice frequently becomes a personal one based upon clinical experience. One meta-analysis of nineteen randomized trials found no clinically meaningful differences between various topical interventions, except that acetic acid was less effective than antibiotic/glucocorticoid drops for patients whose symptoms had not resolved by one week [1]. The overall quality of the studies was low. In our practice, we select therapy based on the severity of external otitis (see "External otitis: Pathogenesis, clinical features, and diagnosis", section on 'Clinical features'):
Oral antibiotics should be used for patients with evidence of deeper tissue infection (outside of the external auditory canal). (See 'Oral antibiotics' below.) Installation and duration of therapy — Proper installation of ear drops entails tilting the head toward the opposite shoulder, pulling the superior aspect of the auricle upward, and filling the ear canal with drops. Patients should lie on their side for 20 minutes or place a cotton ball in the ear canal for 20 minute to maximize medicine exposure. Most topical preparations should be given three to four times daily. Topical fluoroquinolones can be given two times daily. A common cause of failure for topical treatment is underdosing. Patients should be sure that sufficient medication is placed to adequately coat the entirety of the ear canal. It is reasonable to prescribe an initial seven day course of topical medication with instructions to continue up to a total of two weeks for unresolved symptoms. Patients with symptoms persisting beyond two weeks should be re-evaluated for treatment failure. (See 'Follow-up' below.) Wick placement — Direct application of topical agents to the infected site is a key element in the treatment of external otitis, regardless of severity. Patients with severe disease (completely occluded canal) should also have a wick placed. Wicks are commercially available and are made of compressed cotton. They expand as the ototopical medicine is applied. The wick allows topical medications to reach the medial aspect of the ear canal; they also facilitate longer retention of topical solutions in the affected areas. Wicks should be replaced every one to three days if significant swelling persists. Wicks can be removed once ear canal swelling subsides. Wick placement usually requires referral to an otolaryngologist, but can also be performed by the primary care clinician who has previous experience with wick placement. |
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I have reoccurring ear wax, it's annoying and sometimes gets to point of feeling like an ear plug like you described. Tried the Debrox, it really doesn't help much.
Most recently it was stickier and more annoying so I visited an ENT specialist and got some vacuum treatment (very little necessary) and then he got some nasty wax out of the ear that wasn't even bothering me. Wrote a prescription for some antibiotic drops/steroid that I've been using. I'd say go get it checked out, ears are important. |