Serumen Prop

Defenisi Serumen

Serumen adalah hasil produksi kelenjar sebasea, kelenjar seruminosa, epitel kulit yang

terlepas dan partikel debu.

Dalam Keadaan normal serumen terdapat di sepertiga luar linag telinga karena

kelenjar tersebut banyak terdapat pada daerah ini.

Konsistensinya biasa ludang tetapi terkadang kering dan dipengaruhi oleh faktor

keturunan, iklim, usia, dan keadaan lingkungan.

Serumen dapat keluar sendiri dari liang telinga akibat migrasi epitel kulit yang

bergerak dari arah membran timpani menuju ke luar serta dibantu oleh gerakan rahang

sewaktu mengunyah.

Fungsi Serumen :

Sebagai proteksi yaitu dengan mengikat kotoran, menyebarkan aroma yang

tidak disenangi serangga sehingga serangga tidak masuk ke liang telinga.

sarana pengangkut debris epitel dan komtaminan untuk dikelurkan dari

membran timpani.

Pelumas dan mencegah kekeringan dan pembentukan fisura pada epidermis.

Faktor-faktor yang dapat menyebabkan serumen terkumpul dan mengeras

diliang telinga :

1). Dermatitis kronik liang telinga luar

2). Liang telinga sempit

3). Produksi serumen banyak dan kental

4). Adanya benda asing di liang telinga

5). Adanya eksostosis liang telinga

6). Serumen terdorong oleh jari tangan atau ujung handuk setelah mandi atau

kebiasaan mengorek telinga

Serumen dapat dibersihkan dengan konsistensinya.

Serumen Lembek dapat menggunakan kapas yang dililitkan pada pelilit kapas.

Serumen yang keras dapat dikeluarkan dengan pengait atau kuret.

Apabila kedua cara ini tidak dapat mengeluarkan serumen maka dapat

dilunakkan lebih dahulu menggunakan tetes karbolgliserin 10% selama 3 hari.

Serumen yang sudah terlalu jauh terdorong ke dalam liang telinga dapat

dikeluarkan dengan mengalirkan air hangat sesuai suhu tubuh.

Indications

Cerumen in the external ear canal is physiological. Indications to address the cerumen

include the following[4] :

Difficulty in examining the full tympanic membrane

Otitis externa

Wax occlusion of the external ear canal

As part of the workup for conductive hearing loss

Prior to taking the impression for hearing aid fitting

Suspected external ear canal or middle ear cholesteatoma

Suspected external ear canal pathology such as squamous cell carcinoma or

eczema

As part of the follow-up to canal wall down mastoidectomy

As part of grommet insertion or middle ear surgery (preoperatively or

perioperatively)

Patient request

Contraindications

Specific contraindications exist for each specific procedure. Individual assessment

should dictate which technique is the most appropriate.

Contraindications to irrigation include the presence or history of a perforated

tympanic membrane, previous pain on irrigation, or previous surgery to the

middle ear.

A relative contraindication to probing is the inability to visualize the ear canal.

Relative contraindications to microsuction are severe previous exacerbation of

tinnitus, very hard cerumen, and an uncooperative patient.

Exceptional caution has to be used when clearing cerumen in patients who

have undergone a mastoidectomy in the past, during which sensitive

anatomical structures like the facial nerve and semicircular canals may have

been exposed.

Preparation and visual assessment

Assemble and prepare all necessary equipment.

Take time to explain the procedure to the patient and obtain consent.

Connect suction tip and turn on the suction machine and microscope light.

Position the patient’s head facing away from the operator, the neck flexed

laterally and the shoulder pulled down.

Examine the pinna, outer portions of the external canal, and the adjacent scalp

for any evidence of previous surgery incision scars, signs of infection, or

discharge.

Inspect the outer ear canal opening, using the appropriate aural

o The speculum should be the largest size that fits. It should be placed

deep enough to clear the hair-bearing skin but not deeper, as

unnecessary pain may result.

o The speculum should be held with the first and second fingers. Use the

other fingers to retract the pinna up and backward in an adult (retract

the pinna up and downward in a child).

Assess the cerumen. Gently probe with a blunt instrument such as Jobson

Horne curette to determine whether the cerumen is soft, hard, or bony hard.

Assess whether tympanic membrane is visible. Look for any air spaces around

the cerumen.

Before beginning the cerumen removal, ensure that the microscope and

operator are optimally positioned. The microscope should be positioned to

provide the optimal view of the ear canal, and the operator should be sitting

comfortably and with a straight back.