Mustafa MWM1*, Taya UK2 and Ali A3
1Professor of Audiovestibular Medicine, Otorhinolaryngology Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
2Associate Professor of Otorhinolryngology, Otorhinolaryngology Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
3Lecturer of Audiovestibular Medicine, Otorhinolaryngology Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
*Corresponding Author: Mustafa MWM, Professor of Audiovestibular Medicine, Otorhinolaryngology Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
Received:August 15, 2024; Published: September 28, 2024
Citation: Mustafa MWM., et al. “Cerumen in Tinnitus Patients". Acta Scientific Otolaryngology 6.10 (2024):29-35.
Background: Tinnitus is a condition characterized by the perception of sound in the absence of an external stimulus, often manifesting as ringing, buzzing, or hissing noises. This study aimed to investigate whether tinnitus is associated with changes in cerumen (earwax) characteristics among patients.
Method: A total of 289 tinnitus patients were included in the analysis who answered a questionnaire designed for this research.
Results: Significant changes in cerumen properties in some patients. The amount of earwax increased in 20.1% and decreased in 5.9% of patients, while 74.0% reported no change. Notable changes were observed in earwax consistency, with 18.0% experiencing harder earwax and 14.2% experiencing drier earwax. About a quarter of the participants reported color changes, either darker (13.1%) or lighter (12.8%). Changes in the frequency of earwax buildup were noted, with 23.2% experiencing more frequent buildup and 16.6% experiencing less frequent buildup. Chi-square tests showed significant effects of tinnitus onset, duration, and severity on cerumen characteristics. Regression analysis indicated that the duration and severity of tinnitus significantly impacted earwax characteristics.
Conclusion: These findings suggest that tinnitus may influence earwax production and properties, potentially through altered autonomic regulation or changes in ear canal physiology. Understanding the relationship between tinnitus and cerumen changes is crucial for clinical management and further research is needed to explore underlying mechanisms.
Keywords: Tinnitus; Cerumen; Earwax; Ceruminous Changes; Auditory Health; Tinnitus Onset; Ear Canal Physiology; Cerumen Characteristics; Hearing Loss; Tinnitus Severity
Cerumen, commonly referred to as earwax, is a natural substance present in the ear canal, composed of secretions from ceruminous and sebaceous glands, as well as shed epithelial cells. Its composition varies among individuals due to genetic and environmental factors [1].
The ceruminous glands secrete a complex mixture of lipids such as wax esters, squalene, and cholesterol, contributing to the consistency of earwax, while sebaceous glands add oily substances. Earwax also contains keratin and antimicrobial peptides, which help maintain its acidic pH and provide antimicrobial properties [2].
Earwax serves several essential functions. It forms a protective barrier that traps dust, debris, and microorganisms, thus preventing them from reaching sensitive structures in the middle and inner ear. The oily components of earwax moisturize and lubricate the ear canal, preventing dryness and itching. Its antimicrobial properties further protect against infections [4].
However, excessive buildup of earwax can lead to cerumen impaction, causing symptoms like hearing loss, tinnitus and discomfort. Treatment options include ear irrigation or manual removal by healthcare professionals [5]. Changes in the appearance of earwax can sometimes indicate underlying medical conditions affecting the ear canal [6].
Tinnitus is a condition characterized by the perception of sound in the absence of an external stimulus. It often presents as ringing, buzzing, or hissing noises that individuals hear in one or both ears. The exact mechanisms underlying tinnitus are complex and multifactorial, involving alterations in neural activity within the auditory pathways and changes in the brain's response to sensory input [7].
Various factors contribute to the development of tinnitus, including exposure to loud noise, occluding earwax, age-related hearing loss, ear infections, and underlying health conditions such as cardiovascular disease and neurological disorders [8,9]. Psychosocial factors, including stress and anxiety, can also exacerbate tinnitus symptoms [10].
Maintaining ear health and treating associated disorders successfully need an understanding of the makeup, uses, and clinical consequences of earwax. Two tinnitus patients stated that their earwax changed after developing tinnitus; one was evaluated in the Otorhinolaryngology outpatient clinic, while the other visited the Audiovestibular Clinic at Qena University Hospitals. The query "Could cerumen characters change in patients with tinnitus?" surfaced with no answers. Therefore, the purpose of this study is to investigate cerumen alterations that could manifest in tinnitus patients.
Out of the five hundred tinnitus patients who were asked to participate in this study, only two hundred completed an informed permission form before responding to the questionnaire that the researchers had created. The Research Ethics Committee at South Valley University in Egypt gave its approval for the study's design in March, 2024. Artificial intelligence was used to create the questionnaire in both Arabic and English. The authors made changes that resulted in the version utilized in this investigation (Appendices I and II). The questionnaire answers were obtained and analyzed in the period from March to June 2024. SPSS version 29 was utilized for the collection and statistical analysis of the responses.
Eighty-six females and 203 males participated in the study. Their age ranged from 22 to 81 years. Most of them were middle age (mean = 52.25, median = 54 and Mode = 45).
Table 1: Duration of tinnitus.
Sudden onset of tinnitus was reported by 235 participants while 54 only had gradual onset. Severity of tinnitus ranged from 1 to 10 (Mean = 4.34, Median = Mode = 5).
Table 2: Cerumen changes in tinnitus patients.
Table 3: P values in Chi-square tests studying the effect of mode of onset, duration and severity of tinnitus on changes of cerumen (amount, consistency, color, frequency).
There was a negative correlation (degree -.085) with on significance (P = 0.148).
Table 4: Nominal regression analysis to predict the factors that might help us expect the severity of tinnitus.
The study aimed to investigate whether tinnitus is associated with changes in cerumen (earwax) characteristics among patients. A total of 289 participants were included in the analysis, revealing significant insights into the relationship between tinnitus and cerumen changes. Tinnitus patients were grouped according the duration of tinnitus (Table 1).
The amount of earwax increased in 20.1% and decreased in 5.9%. A substantial majority of patients (74.0%) reported no change in earwax amount (Table 2). This suggests that tinnitus might influence earwax production in a minority of patients.
The most significant changes were reported in earwax consistency, with notable increases in hardness (18.0%) and dryness (14.2%). Over half of the participants (54.7%) observed no changes in consistency, indicating a varied response among individuals (Table 2).
Color changes were reported by about a quarter of the participants, equally distributed between darker and lighter changes. However, the majority (74.0%) did not notice any color alteration (Table 2).
Changes in the frequency of earwax buildup were noted, with 23.2% experiencing more frequent buildup and 16.6% experiencing less frequent buildup (Table 2).
The chi-square tests evaluated the influence of tinnitus onset, duration, and severity on cerumen characteristics (Table 3). Significant results (p < 0.05) were observed for changes in earwax amount, consistency, and color concerning the mode of onset and duration of tinnitus, except for the frequency of earwax buildup, which was not significantly affected by the onset mode (p = 0.195).
Regression analysis indicated that the duration of tinnitus had a significant impact on earwax characteristics (p < 0.001 for all factors). Severity of tinnitus was also a significant predictor of earwax changes (p < 0.001 for all factors; Table 4).
These findings highlight the complexity and variability of cerumen changes among tinnitus patients. While a majority did not observe changes in cerumen characteristics, a notable proportion experienced significant alterations, particularly in earwax consistency and buildup frequency. The results suggest that tinnitus might influence earwax production and properties, potentially through altered autonomic regulation or changes in ear canal physiology associated with tinnitus.
Understanding the relationship between tinnitus and cerumen changes is crucial for clinical management. Healthcare providers should be aware of the potential for these changes and consider them when diagnosing and treating tinnitus patients. Regular ear examinations and patient education on ear hygiene might be beneficial in managing symptoms associated with cerumen buildup.
Further research is needed to explore the underlying mechanisms of these changes and to determine whether specific subgroups of tinnitus patients are more susceptible to cerumen alterations. This study provides a foundation for future investigations and highlights the importance of comprehensive patient assessment in tinnitus management.
Tinnitus may lead to changes in cerumen production as well as its properties, potentially through altered autonomic regulation or changes in ear canal physiology.
Copyright: © 2024 Mustafa MWM., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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