Unusual cause of ear wax

Sir,

We were provoked to write this short piece after we encountered around 50 cases presenting to us in Otorhinolaryngology OPD (from August 2020 till May 2021) at our institution with an atypical cause of ear wax. The current COVID-19 pandemic has imposed the worldwide use of masks in addition to social distancing. With this background, we present an interesting cause of ear wax. We had 186 patients coming to the OPD with ear wax out of which only 50 adult patients never had accumulation of wax before. Patients using ear buds on regular basis, using earphones/ headphones for prolonged durations i.e., more than one hour/day, history of ear discharge or any otological surgeries in the past, using masks with strings were excluded from the study. Patients in the age group of 12-60 years who have never had accumulation of wax before, using face masks with loops and are having ear wax in unilateral/bilateral or both ears were included in our study. All the patients received a questionnaire with the inclusion and exclusion criteria and questions regarding the duration per day for which they wore the face mask with loops. The patients did not have any history of earache, trauma, ear discharge and hearing loss. General physical examination and local ENT examination was unremarkable. Otoscopic examination revealed ear wax. There were no signs of inflammatory changes in the ear canal. Interestingly, they never had similar complaints before nor had their ears cleaned for the same. Our cases were managed with the help of wax dissolving ear drops [Benzocaine (2.7% w/v)+chlorbutol (5% w/v) + Paradichlorobenzene (2% w/v) + Turpentine Oil (15% w/v)] and traditional ear syringing method.¹ There was only one common factor between those 50 adults which was that they all wore mask with loops over the ear.

We would like to highlight that these face masks with ear loops can cause pressure on the skin of the posterior concha of the auricle for a long time and can disfigure the external auditory canal opening.² This type of face mask can distort the ear canal opening and thus hinder the natural mechanism of ear cleaning eventually leading accumulation of ear wax.³ The mean duration for which the patients wore the face masks with loops was 6.5 hours a day. It is astonishing to note that even the use of face masks with loops for 6.5 hours a day is enough to induce accumulation of ear wax as noted in our study. We are confident that highlighting this potential complication will stimulate the search for alternative solutions, while maintaining the possibility of prevention of the potential spread of the virus. This article will help in designing better quality masks in the future and raise points for research.

REFERENCES

1. 1. Kumar S, Kumar M, Lesser T, Banhegyi G. Foreign bodies in the ear: a simple technique for removal analysed in vitro. Emergency Med J. 2005;22(4):266-8.
2. 2. Woo JE, Park Y-H, Park EJ, Park KY, Kim SH, Yim S-Y. Effectiveness of ear splint therapy for ear deformities. Ann Rehabil Med. 2017;41:138-47.
3. 3. Griffin MF, Premakumar Y, Seifalian AM, Szarko M, Butler PEM. Biomechanical characterisation of the human auricula cartilages; Implication for tissue engineering. Ann Biomed Eng. 2016;44:3460-7.