Sulfur plug: causes and symptoms

Narrated by Alexander Slavskiy,

otorhinolaryngologist, doctor of the highest category, Ph.D.

Many people have been living with a feeling of stuffiness in their ear for years and simply do not pay attention to it until more serious symptoms appear - acute aching or shooting pain in the ear. And the reason for this is often ordinary sulfur plugs. According to statistics, approximately 4% of the Russian population suffers from them. 

What is a sulfur plug? 

A sulfur plug is an accumulation of earwax, sebaceous gland secretions, and exfoliated skin cells. It consists of lipids, glycoproteins, hyaluronic acid, enzymes and immunoglobulins. Normally, sulfur protects the ear canal from damage. 

There are a number of glands in the skin of the human external auditory canal: sweat glands, sebaceous glands that produce sebum, and sulfur glands that produce sulfur. As for the sulfur glands, there are about 2000 of them localized in the external auditory canal, they secrete up to 12-20 mg of earwax per month. Earwax contains proteins, mineral salts, and free fatty acids. Some of the proteins are immunoglobulins that perform a protective function. The pH level of earwax is 4.0-5.0, which counteracts the development of bacterial and fungal flora. In addition, sulfur contains dead cells, sebum, dust, and other inclusions. 

Normally, earwax leaves the ear canal when talking or chewing, due to the movement of the lower wall of the ear canal, when the temporomandibular joint moves. However, due to some reasons, sulfur removal does not occur, and sulfur plugs form. Anatomically narrow and convoluted types of structure of the external auditory canal can be conditions that prevent the removal of sulfur from the ear.

Causes of sulfur plug formation

The following causes may also be prerequisites for the occurrence of sulfur plugs: dermatitis, otitis media, increased humidity or dustiness of the air, the use of hearing aids, headphones, improper ear toilet, etc. The nature of symptoms in the presence of a sulfur plug depends on its location, and can manifest itself as a normal hearing loss as a result of blockage of the ear canal, and accompanied by Additional symptoms include headaches, dizziness, cough, nausea, and sometimes cardiac arrhythmias.

Signs of a sulfur plug

At the same time, the common and main symptom of a sulfur plug is a feeling of stuffy ear. At the moment when the ear canal is completely blocked, a sudden sharp hearing loss occurs. This is usually due to the ingress of water into the ear and the swelling of sulfur. In this case, there may be noise in the ear. Prolonged exposure to sulfur plugs often leads to inflammation in the middle ear. 

Diagnostics of sulfur plugs

Diagnosis of sulfur plugs is not difficult, the diagnosis is based on typical complaints and a visual assessment of the condition of the ear. There are many ways to remove a sulfur plug. The most common methods are washing the ear, or directly removing the plug using an aspirator. 

Leaching of the sulfur plug

Today, the most common method among otolaryngologists to remove a sulfur plug is to wash it out. Before starting the procedure, it is recommended to instill oil drops into the ear canal, which facilitates the extraction of the sulfur plug. In this case, negative sensations such as stuffiness, tinnitus, and sometimes pain may occur. In rare cases (about one in a thousand washings), more serious complications of this procedure are noted - injuries to the eardrum, nausea, vomiting, the development of otitis externa, vestibular disorders. Therefore, washing out sulfur plugs cannot be considered an absolutely safe and generally available method of treatment, especially in children. 

Earwax solvents

There is another effective method of therapy – cerumengolysis, which is based on the introduction of special substances into the lumen of the ear canal - cerumenolytics that dissolve earwax, as a rule, they contain carbamide peroxide or sodium bicarbonate. Penetrating inside the sulfur plug, these and similar preparations dissolve it without causing swelling. Contraindications for the use of cerumenolytics are mainly individual intolerance to the drug or injury to the eardrum, as well as an age limit of up to 2.5 years. 

Vacuum aspiration of sulfur plugs

In our clinic, otorhinolaryngologists mainly use the "dry method" of removing sulfur plugs - vacuum aspiration, which helps to avoid all the above complications. Whichever method the attending physician chooses, getting rid of this little nuisance is a painless procedure that takes a few minutes, but allows our patients to hear fully and avoid more serious ear diseases in the future. Independent attempts to get rid of the plug can end up unfavorably for your hearing, so doctors at the Otorhinolaryngology Clinic recommend that you contact specialists if you encounter a problem with sulfur plugs.

Author: Alexander Slavskiy, otorhinolaryngologist, doctor of the highest category, PhD