ABSTRACT
The external ear or pinna is constructed of a cartilage skeleton covered by skin and soft tissue. The cartilage forms an outer helix and an inner antihelix. The external canal consists of a cartilaginous outer third and a bony inner two-thirds. It is angled and needs to be straightened before examination is attempted. This is done by gently pulling the pinna posterosuperiorly. This aligns the cartilaginous canal with the bony canal and should allow visualization of the entire canal and tympanic membrane. Wax is produced by the hair-bearing skin of the external auditory canal. Wax is a combination of desquamated skin and cerumen formed by glands in the base of the hair follicles. Wax is amenable to removal by non-specialists by water syringing most commonly using a pressure-controlled irrigator. In primary care settings various wax softening agents including olive oil, sodium bicarbonate and commercial agents such as Cerumol are frequently used to aid wax or ease of wax removal.
