Means for dissolving earwax. Sulfur plug (cerumen) - causes and mechanism of formation, symptoms and treatment

Wax plug is a buildup of wax in the ears that is not removed naturally. If it is contained in large volumes, then there is a possibility of a complete overlap of the ear canal. The consequences of this is a decrease in the quality of human life, in addition, it often becomes the cause of weakness and ailments. Fortunately, all this can be corrected if appropriate measures are taken.

What is earwax

Earwax is a natural substance that is produced in the ears of all mammals, and humans are no exception. It is widely believed that it indicates uncleanliness, but this is an erroneous opinion, since it is sulfur that keeps the ear passages clean.

How does she manage to do this? It filters incoming particles of debris, dust and chemicals, such as shampoo. In this way, it protects the ears from infectious diseases.

It is known that the ear canal is "final", that is, dead cells cannot be removed from it by erosion. Sulfur solves this problem, as it is produced by the sebaceous glands and contains cholesterol.

Reasons for the formation of sulfur plug

In accordance with the statistics compiled by medical researchers, there are two main reasons that affect the formation of a cork consisting of sulfur. These include:

• Excessive formation of sulfur.
• Individual anatomical features of the passage.

Often people themselves cause the formation of cork, which is caused by their excessive concern for the cleanliness of the ears. Excess is the cause of the opposite effect. It is known that the main task of sulfur is to protect the inner ear. The constant manipulations associated with its cleansing will become a signal to the body, after which this natural substance will be released in a double, and sometimes triple volume. The signal is given for the reason that sulfur serves as a protective component, without which the ear canal will remain unprotected.

The constant use of cotton swabs as a means of cleaning the auricle causes the wax to become denser and “move” into the inside of the passage. After a period of time after such cleaning procedures, a dense plug is formed. According to the anatomical structure, the ear is arranged in such a way that excess sulfur can be removed independently (for example, when a person eats food or pronounces words). That is why our task is to keep only the outer part clean, and an attempt to penetrate deep into the passage can cause a blockage.

Other factors causing its development are:

• Various diseases (for example, ekzama);
• High levels of dust and debris in the air;
• Constant use of headphones;
• Regular use of hearing aids.

Sulfur plug symptoms

The formation of a sulfur plug is accompanied by a number of characteristic features. These include:

• Ear congestion - this feeling does not go away for a particularly long time after sleeping or taking water procedures;
• Frequent noises;
• Feeling the return of one's own voice;
• The beginning of inflammatory processes caused by blockage of the passage.

These are all specific symptoms, but congestion can cause other symptoms as well. These include coughing, nausea, severe dizziness and pain in the heart.

Attention! Often, excess sulfur does not make itself felt, so the decrease in hearing ability occurs gradually and continues until a small gap remains.

What not to do when removing a cork

Self-treatment of an ear plug is welcome only in cases where the diagnosis is 100% certain. Otherwise, the treatment started may cause a deterioration in hearing ability, loss of hearing acuity and discomfort.

When getting rid of the cork, it is strictly prohibited:

• Use objects with a sharp tip, such as toothpicks;
• Contraindication is diabetes mellitus;
• Perforation of the eardrum;
• It is forbidden to carry out treatment for inflammation of the auricle.

It is also worth noting that removal using a cotton swab causes it to enter the inside of the ear canal. This will aggravate the situation and cause pain.

The formation of sulfur plug must be avoided, but if it already exists, then the topic of getting rid of it must be approached competently. The most effective option is to contact an ENT doctor. The exceptions are situations when you are sure that the cause of the symptoms is a sulfur plug, then you can make an attempt to get rid of it yourself.

It is important that when removing the cork, you must adhere to the established algorithm, otherwise the treatment will not show results. Procedure:

1. The first step is to soften the sulfur lump. For these purposes, it is required to prepare a pipette, a cotton swab and a softening agent (you can use glycerin or vegetable oil, less often hydrogen peroxide is used). It is necessary to warm up five drops of the product in your hands, then drip it into the ear located on top (you need to tilt your head). When instilling the remedy, with the fingers of the other hand, it is required to pull the edges of the auricle. After the procedure is completed, a tampon must be placed in the passage.
2. The next step is to rinse the sulfuric plug, which will require a syringe and 3% hydrogen peroxide. This procedure is carried out the next morning. Flushing is required to be carried out lying on your side so that the ear is located at the top. The ear canal must be filled with the agent until it overflows. This completes the washing, but in this position you need to stay for another fifteen minutes.
3. The final stage involves the final disposal of sulfur accumulation. This requires a jet of warm water under pressure, for which a shower hose can be used (previously remove the nozzle that sprays water). It is required to start flushing from a short distance, constantly bringing it closer to the ear.

• The first stage - softening the cork is recommended before bedtime;
• For its complete removal, it may require procedures several times;
• If after 3-4 approaches there is no relief, then you should contact the specialists.

1. Almond oil is an excellent remedy. The treatment will require about seven drops, which must be heated before use.
2. Baked onion juice is one of the most effective ways. To get rid of the cork, four drops are needed, after which a swab previously lubricated with petroleum jelly is placed in the ear canal.
3. Douching with salt water is one of the most commonly used techniques. This will require 50 ml of water at room temperature, in which you need to dilute a teaspoon of salt.

If the sulfur plug is too dense, then it is removed by a doctor. The procedure takes place in two ways - by the dry method or by washing the external passage using special tools.

Pharmaceutical remedies for congestion in the ears

To get rid of the sulfur plug, you can refuse to use folk recipes by choosing pharmacy products. Drops are prescribed if the seals have a solid consistency. Used:

1. Hydrogen peroxide with 3% concentration. The lumps of sulfur softened by it will be pushed out on their own.
2. Remo Wax. These drops are prescribed for use twice a month. Do not use them for pain, fluid release or membrane defects. Drops prevent constant cleaning of the ear passages with cotton swabs.
3. A-cerumen. These drops are prescribed to remove seals in the ear canal, and can also be used as a preventive measure. The duration of the use of the tool is not limited.
4. Auro or Drops - drops that allow you to dissolve the ear plug. They are appointed in accordance with the instructions. The active substance is carbamide peroxide.

Prevention of ear plugs

As noted above, sulfur plug is often the cause of improper cleaning of the ears, so the main preventive measure will be familiarity with the main principles of ear hygiene:

• It is required to remove earwax only from the auricle;
• It is allowed to clean the opening of the ear canal from the outside;
• If you suspect the formation of an ear plug, you should immediately visit a doctor.

The ENT doctor examines the ear canal, which reveals excess sulfur. When the diagnosis is approved, professional cleaning takes place. It is recommended to undergo it regularly for people suffering from excessive hair growth in the passage, as well as for owners of devices that restore hearing function.

Often, sulfur plug appears due to inflammatory diseases, so their treatment must be carried out in a timely manner. One of the preventive measures is the treatment of dermatitis and eczema. To avoid the formation of a cork, it is necessary to constantly monitor the level of cholesterol in the blood.

Sulfur plugs must be removed as soon as they are found, otherwise the consequences can be sad. The doctor will competently carry out the procedure, relieving the symptoms, but you can cure the seal yourself. For this, actions must be carried out regularly, without neglecting them. After getting rid of the cork, it is recommended to pay special attention to preventive measures in order to avoid recurrence.

Video: what's in your ear: wax plug

Sulfur is produced by the ear glands, it protects the hearing organs and is removed by itself, for example, when chewing. But sometimes its quantity for various reasons becomes higher than the norm, it begins to accumulate and thicken. There is an obturation (closing of the hollow canal) of the external auditory canal, and a plug of earwax is formed.

It can appear in people regardless of their age and gender, but it occurs more often in children. You should not experiment with your health, it is better to use A-cerumen and Remo-vax preparations, they will cope with any traffic jams.

Heal quickly and painlessly

Sulfur plugs come in different colors, compositions and densities, so it is not recommended to get rid of them on your own, it is better to contact an otolaryngologist with your problem. After examining the patient, the doctor will select the medicine and prescribe a course of treatment.

Soft formations are simply washed out, hard ones are pre-softened with hydrogen peroxide. Sometimes such treatment does not give the desired effect, and medications under the general name "cerumenolytics" are prescribed to remove the plugs.

One of these products in the form of drops and spray is Remo-Vax. It quickly and reliably acts for treatment, preventive and hygienic procedures in case of accumulation of sulfur in the ears.

Indications for use:

• with a decrease in auditory perception in old age;
• for the treatment of people suffering from allergic reactions;
• for cleansing the ear canal for children from birth;
• with increased formation of sulfur plugs;
• people who often use headphones, a telephone headset;
• with regular swimming in pools or other bodies of water, working in contaminated rooms.

It is allowed to use pregnant women and breastfeeding.

Remo-Vax contains mink oil, lanolin, sorbic acid,
allantoin, benzethonium chloride, excipients.

Fights congestion, soothes, moisturizes. But with undoubted benefits, like all drugs, there are contraindications:

1. The tympanic membrane is injured.
2. Painful sensations in the ear.
3. Hyperesthesia (hypersensitivity) to the components included in the drug.
4. Discharge from ear passages.

A contraindication may be an allergic reaction to some components of the product and individual intolerance.

Follow instructions

It is necessary to use the drug according to the instructions, otherwise it may not bring the proper benefit. When instilled, the medicine should have body temperature, therefore, before the procedure, it should be warmed up a little, you can use it in your hands.

Drops

Lay the patient on the side, pull the earlobe back and up if the patient is an adult. Drip the medicine, it should be at the level of the transition of the canal into the ear shell. It is not allowed to introduce A-cerumen into the middle of the channel, so that a plug from the air does not form. Children are treated in a similar way, but the earlobe, when instilled, must be pulled back and down.

In this position, the patient should be 8-10 minutes. Then turn it over to the other side, having previously placed a napkin under the ear. Liquid with liquefied sulfur should flow onto it, so if it is dark in color, do not worry.

Thus, instill the drug daily in the morning and evening for 5 days. To treat a severe form, keep the drug in the ear for up to 30 minutes. Bury 2-3 times a day, repeat the procedure for 3-5 days.

It does not contain antibiotics and other aggressive substances, therefore it is used at any age.

After the procedure, do not cover the ears with cotton for free waste of sulfuric secretions.

Spray

Before the first medication or if it has not been used for a long time, make 2-3 sprays into the air or a napkin.

Insert the spray tip into the external auditory canal and make 2-3 injections, pulling the lobe back and up. The drug begins to act in 30-60 minutes. To remove residual sulfur, rinse the canal with a microsyringe with warm water.

After using the can, remove the tip, rinse it with warm running water, rinse thoroughly and dry. The product may only be used with a tip.

If Remo-Vax gets on the mucous membranes, thoroughly rinse these areas with running water.

If the use of the remedy does not bring relief, it is necessary to adjust the treatment by contacting your doctor.

For hygiene procedures and for preventive purposes, the medicine is used 2 times a month, as practice shows, this is enough to prevent traffic jams.

Drops of yellowish color in a plastic bottle with a dispenser of 10 ml. Packed in a cardboard box of 1 bottle, along with instructions for use.
Price: from 360 rubles per pack.

Spray - packed in plastic bottles with a spray tip of 10 ml. In a cardboard box 1 bottle and instructions for use.
Price: from 290 rubles for 1 bottle.
Shelf life - 4 years.

A-cerumen - the winner of traffic jams

If in adults plugs occur due to irregular cleaning of the ear canals, in children due to too frequent removal of sulfur. A-cerumen dissolves sulfur, softens, cleanses and moisturizes without causing irritation.

Cotton swabs should not be used to clean the ear canal - only for the hygiene of the auricle.

The composition of the drug includes active ingredients,

• cocobetaine;
• teacocoylhydrolyzed collagen;
• peg 120-methylglucosodioleate;
• surfactants - contribute to the dissolution of sulfur plugs.

The main indication for use is the elimination of sulfur in the ears, the cleansing of the hearing aid and to prevent the formation of traffic jams.

The drug contains active ingredients, so it is not recommended to use:

1. With an allergy to the components of the drops and with individual intolerance.
2. If the use of the medicine causes pain.
3. If fluid comes out of the ear canal.
4. With perforation of the tympanic membrane.
5. If there are infectious and inflammatory processes in the auricle, regardless of the form - acute or chronic.
6. Children up to 2.5 years old.
7. If there is a shunt in the eardrum.

This sulfur plug medicine sometimes causes dizziness and allergic reactions.

Correct Application

Scheme of treatment with drops:

Measure out 1/2 of the bottle. Lay the patient on his side, insert half of the bottle into the ear canal. The patient must hold this position for at least 1 minute. Perform the same procedure with the other ear, using the rest of the medicine. Finish by rinsing with saline or water using a microsyringe.

For treatment, instill twice a day - in the morning and in the evening. The course is 3-4 days. For preventive purposes, it is recommended to use the drug twice a week.

Spray treatment - make one injection in each ear, leave for 1 minute. Then tilt your head so that the liquid flows out, rinse with saline.

Apply with traffic jams in the morning and evening for 3-4 days, for prevention it is enough to inject 2 times a week.

How does A-cerumen work? Drops or spray, when exposed to sulfur, dissolve it. Due to the surfactants contained in the drug, the agent does not allow the cork to increase and makes it easy to remove it from the auricle. The agent acts gently, does not cause irritation.

The drug is packaged in plastic dropper bottles of 2 ml.
The cost of packaging (5 droppers) is from 300 to 450 rubles.
The shelf life of the drug is 3 years, after opening the vial should be used within 24 hours. Store at room temperature.

In the form of a spray - placed in plastic bottles of 40 ml with a spray.

The cost of packaging (1 bottle) - from 450 rubles.

Means for getting rid of traffic jams Remo-vax and A-cerumen have proven themselves well in eliminating such an unpleasant problem as earwax. They are easy to use, affordable, easy to purchase in pharmacies or through online stores. Which is better - Remo-vax or A-cerumen, it is up to the attending physician to decide.

Wax plug in the ears is a problem that occurs among patients of various age categories. The main way to deal with the problem is to wash the ear canal or use special preparations. Drops from sulfuric plugs in the ears soften the plug in the ear and contribute to its speedy removal to the outside.

Types of drops used and indications for their use

Drops from the sulfur plug should be prescribed by an otolaryngologist. He chooses the appropriate remedy, taking into account the characteristics of the problem. All drugs in this group are divided into 2 categories:

• water;
• oil.

The therapeutic effect when using ear drops from sulfur plugs is the gradual loosening of the formed clot and its gradual withdrawal from the ear canal. Drops for dissolving sulfur plugs are recommended for the following categories of citizens:

1. Swimming people. The ingress of fluid into the ear canal contributes to the swelling of deposits.
2. Persons who wear hearing aids. With prolonged use of the device, the ear canal is filled with a large amount of sulfuric matter.
3. Children of preschool age. In young children, the ear canals are narrower than in adults. For this reason, even a small amount of the substance provokes blockage of the passages.
4. Persons working in a dusty environment.
5. Elderly patients who have hearing pathologies.

Ear drops are a quick fix. They are suitable not only for the treatment of pathology, but also for its prevention.

Rules for choosing drugs

The range of products for removing sulfur plugs is huge, so it is difficult for patients to choose the right drug. When choosing drugs, you need to pay attention to the following characteristics of the drug:

1. Compound. It is important that among the components of the drug there are no substances that can cause an allergic reaction.
2. Age indications. When choosing a medicine for a child, it is important to make sure that the drops have no contraindications for his age group.
3. Release form. It is important that the drug has an ergonomic bottle, which is enough for the entire period of treatment.

Review of effective drops from cork in the ears

The choice of a suitable drug largely depends on the age of the patient. Preparations for dissolving sulfuric plugs are divided into children's and adults. Drugs intended for adults can provoke many side effects in children, and children's drops will be ineffective in combating the problem in patients of mature age.

Baby drops

Among the effective drops for removing sulfur plugs are:

1. A-Cerumen. The medication quickly and gently cleans the ear canal from deposits. The tool is used to treat pathology in adults and children from birth. The main component of the drug is surfactants. The substance does not irritate the ear canal. The action of the drug begins a few minutes after instillation. The average price of A-Centrumen is 300 rubles.
2. Otipax. The main action of the drug is antibacterial and anti-inflammatory. The dosage of the drug is determined by the attending physician. The main substances in the drops are phenazone and lidocaine. The last component will reduce the intensity of pain in case of a problem, the first one inhibits the production of sulfur. The course of therapy with ear drops is 10 days. Otipax can be used in children from 1 year of age. Among the contraindications to the use of the drug can be distinguished: allergic reactions to the components of the drug. The average cost of Otipax is 200 rubles.
3. Aqua Maris Oto. The drops are intended for children and people who use headphones or a hearing aid. Aqua Maris Oto is used to soften the ear plug in children from 4 years old, pregnant women and nursing mothers. The main contraindications to the use of the drug are inflammatory diseases of the ear and pathology of the tympanic membrane. The cost of the drug is from 500 rubles.

Adult drops

Popular drugs for removing sulfur plugs in adults include:

1. Remo wax. Drops allow you to gently remove deposits from the ear canal and prevent the recurrence of the problem. The medicine can also be used in cases where a foreign body is constantly in the ear canal, such as a telephone headset or a hearing aid. Penetrants, which are part of the drug, contribute to the speedy removal of dead particles from the ear canal. The cost of Remo-Vax drops is 350 rubles. Contraindications to the use of the drug: discharge from the ear, deformation of the eardrum.
2. Hydrogen peroxide. The drug quickly dissolves sulfur deposits in the ears and clears the passages. After applying the medication, the plugs come to the surface of the auricle on their own. In the absence of eardrum pathologies, hydrogen peroxide can be used to remove any sulfur clots. The course of treatment with the drug is 3 days. Peroxide is instilled 4-5 times a day. The cost of the medicine is 10-15 rubles per bottle.
3. Otex. The main components of the drug include: D-panthenol, salicylic acid and willow bark. Due to these substances, the drops simultaneously have an antimicrobial, anesthetic and dissolving effect. After the use of the drug, there is an accelerated renewal of the tissues of the ear canal and the normalization of sulfur production. The product is available in a glass bottle and is sold at a price of 1100 rubles.
4. Vaxol. Drops consist entirely of olive oil. It eliminates the pathogenic flora inside the auricle. Vaxol is used not only to split the sulfuric plug, but also to prevent the recurrence of the problem. One bottle is designed for 200 sprays. This amount is enough to perform preventive procedures for 6 months. To eliminate the problem, the medicine is used 2 times a day for 5-7 days. The cost of the drug is 500 rubles.

Rules for using drops

Ear drops are prohibited for oral or other use. The method of using various drops to remove the sulfur plug from the ear is the same:

• Before use, the drug is slightly heated to a temperature of 37 degrees. This can be done with the palms of your hands or a water bath.
• The patient should take a supine position so that the treated ear is parallel to the floor surface.
• The warmed medicine is injected closer to the edge of the ear to avoid the formation of an airlock.
• Try to insert the pipette tip shallowly.
• After the procedure, the patient remains in the supine position for another 1-2 minutes.
• The outer part of the ear is washed from the remnants of the drug with warm water or sodium chloride.

If the ear plug has a large volume, then the dosage of the drug can be increased. For example, A-Cerumen is instilled with a vial into each ear canal.

The duration of the use of ear drops is unlimited, they can be used, as well as toothpastes, throughout life.

The ear is treated with hydrogen peroxide according to the following algorithm:

• The person is located on the side opposite to the sore ear.
• After foaming and hissing of the liquid, particles of earwax are removed with a cotton swab.
• The auricle is cleaned of peroxide residues.

Hydrogen peroxide is used with extreme caution. The more concentrated the medicine, the more likely it is to develop side effects from removing plugs from the ears.

The last instillation procedure is preferably carried out 15 minutes before bedtime. Before treatment, it is recommended to warm the ear a little with dry heat. This will increase the effectiveness of the drops used and dry out the ear canal. If there is no result from therapy after 5 days, you should contact an otolaryngologist.

Contraindications and side effects

It is forbidden to use drops for resorption of earwax without a doctor's prescription. Among the absolute contraindications to the use of the drugs in question, there are:

• allergic reactions to the components of cerumenolytics;
• discharge from the auricle;
• injury to the eardrum;
• inflammation of the ear cavity.

An overdose of cerumenolytic preparations is not possible, since they are intended for external use.

If used incorrectly, drops can cause the following negative reactions:

• dizziness;
• skin itching;
• headaches;
• discomfort in the ear.

Such symptoms in most cases develop due to the patient's hypersensitivity to the components of the drug. Side effects can be supplemented by skin rashes, a burning sensation in the ear. If negative signs appear, you should immediately stop using the drops and seek the advice of a doctor.

Use during pregnancy and lactation

Cerumenolitics can be used during gestation and breastfeeding, as they have a local effect on the problem area and are not absorbed into the blood. It is also possible to combine the preparations with the use of other drops and ointments for the ears. At the same time, there were no cases of drug overdose, even when used together.

The instructions for the medication indicate under what temperature conditions it should be stored. It is important that the drops are located in places inaccessible to children.

An effective and safe remedy for removing sulfuric plugs is ear drops. To achieve the maximum effect of therapy, you must first consult with your doctor. Only a specialist can choose the right drug, taking into account the complexity of the problem and the individual characteristics of the patient. Side effects from the use of medications are observed in rare cases. Most often this happens when ignoring contraindications to the drug or non-compliance with its dosage.

The formation of plugs in the ears is a problem that affects all age groups. Struggling with an unpleasant sensation by washing, as well as instillation of means to dissolve sulfur accumulations.

Ear drops based on the softening of sulfuric plugs should be in the medicine cabinet for people with impaired secretion of the sulfuric glands. Let's look at which ear plug drops are most effective and safe.

Causes of traffic jams

Sulfur protects our body from all sorts of irritants. Special glands are responsible for its production. In the normal state, the secretion leaves the auditory canal on its own when the temporomandibular joint is manipulated.

The increase in sulfur production occurs for many reasons and, first of all, it depends on the structural features of the hearing organ, genetic predisposition. Often production increases with metabolic failures, microtrauma, prolonged listening to music in headphones.

What causes ear plugging

In addition, improper cleaning and age-related changes can affect the size of secretion production. In the first case, with ear sticks, we disrupt the natural process of wax leaving the ear canal.

With recurrent changes, the body independently loses the natural property of removing sulfur, in addition, the number of hairs in the auditory tube in the elderly increases, they delay secretion.

How does wax accumulation affect the ear?

Dust particles, water and keratinized skin structures that have entered the ear, mixing with sulfur, become a viscous mass that blocks the auditory canal. Over time, this consistency may become rocky. Then, to dissolve sulfur plugs, ear drops are used, which destroy the structure of the substance and bring its remnants out.

Such education brings discomfort in the form of hearing loss, and sometimes accompanied by pain. All because the accumulation of sulfur puts pressure on the eardrum. It is necessary not to guess what caused the unpleasant symptom, but it is better to contact a specialist in a timely manner.

Clearing traffic jams in the doctor's office

Ear plug symptoms

Sulfur formation may not make itself felt for a long time, until it obscures the entire ear canal. Discomfort is noticed, as a rule, when bathing. Liquid penetrates into the ear, sulfur after contact with it begins to increase and completely blocks the opening.

Sulfur accumulations are located both on the eardrum and nearby. In addition to water, the nerve receptors of the ear help to detect the cork. They come into contact, irritation begins to go, nausea, dizziness, coughing appear.

If these symptoms are present, you should consult a doctor. Otherwise, the constant interaction of sulfur with the eardrum can cause an inflammatory process. What drops can be taken for otitis media, see here. In order not to wait for the channel to be completely blocked, you need to apply drops to the ears, which will immediately get rid of the sulfur plug without any effort.

Besides, it is possible to use cerumenolytics for preventive purposes to avoid excess sulfur production. These funds are recommended for people with hearing aids, swimmers, children, the elderly and those whose activities take place in a dusty place. If the ears are stuffed up with a cold, what can be done, read here.

The most common drugs

Drops are prescribed only by an otolaryngologist based on the characteristics of each patient and the type of disturbing plug. Since the auditory analyzer is constantly exposed to the onslaught of the external environment, congestion agents help to create gentle care, cleanliness and health of the auditory analyzers.

How to properly treat ear congestion can be viewed here.

Cleaning wax with ear sticks is unacceptable

Seeing the ubiquity, the pharmaceutical market provides an impressive selection of drugs to combat this problem. There are two main groups of funds:

1. Water based. These include: Aqua Maris Oto, Remo-Vax, Audispray, Otex, A-cerumen, Colace, hydrogen peroxide.
2. Oil based. This includes Waxol, Cerustop and Earex etc.

All ear drops for removing wax plugs have nozzles for easy application. The exception is hydrogen peroxide. It is instilled with a pipette. It is impossible to answer exactly which drugs are better. Let's take a look at the most common drugs separately.

Aqua Maris Oto

At the heart of the drops from the sulfur plug is a natural component, which is famous for its therapeutic effects in case of ailments of the upper respiratory tract. Drops do not have aggressive components, so they can be used in children from the age of one.

The solution is very easy to apply. Manipulations are best done over the sink. You need to tilt your head to the side and make an injection into the ear canal. When sulfur appears, it is removed with a napkin. To completely remove the cork, you need to use the solution for several days in a row.

What is better to drip into the ear

Remo Wax

These drops are the most popular. They are distinguished by a complex action, that is, they are aimed not only at the lysis of the formed sulfur, but also at the restoration of secretion production. The medicine is safe and used from infancy, because it does not carry aggressive components and antibiotics.

The structure of Remo-Vax contains many surfactants, as well as allantoin, phenylethanol and sobric acids. These components narrow the pores and moisturize the epithelium inside the ear.

Drops are used in the following way. As a prophylaxis, it is prescribed no more than 1-2 times a month. To release fresh sulfur secretion, 15–20 drops of a slightly warmed solution are dripped. Then cotton wool is laid there and rested for 30–60 minutes or left overnight.

To remove the stony formation, douching is carried out. The drug should be injected under little pressure until clear fluid comes out of the ear. The procedure is carried out once a day for three days.

A-cerumen

This remedy for plugs in the ear contains components that clean the ear canal and prevent the increased release of sulfur. The drug can be combined with other medicines. It is presented in two forms: drops and spray.

The tool does not show any systemic effects, so it is allowed to use during pregnancy, lactation and citizens with a burdened history. A-Cerumen breaks down sulfuric fat, thanks to the presence of surfactant components.

The drug A-cerumen

The only disadvantage of the drug is that it cannot be used for otitis media, deformation of the membrane and the presence of a tube for ventilation of the middle ear. As a prophylaxis, apply twice a week. During treatment, manipulations are carried out once, twice for 3-4 days.

Cleansing with this solution is much faster than in previous cases. To do this, one injection is made into the passage of each ear. After a minute, you need to tilt your ear to one side so that the substance with sulfur begins to come out unhindered. Next, the ear is washed with saline or boiled water and dried.

Otipax

The drug is used in the treatment only by appointment of an otolaryngologist. The doctor prescribes a strict dose of the drug, because it is individual for different age groups. Drops have an antiseptic and anti-inflammatory effect.

The structure of the drug includes Phenazol, which promotes the production of prostaglandins and Lidocaine, which reduces the pain threshold. Otipax is forbidden to drip with a history, as well as children with allergies to existing components.

It is permissible to take the remedy for children from one year. The duration of treatment is up to 10 days. For children, 4 to 8 drops are prescribed. Here you can learn how to take Otipax drops. Note that self-medication with this drug is dangerous.

Otipax drug

Hydrogen peroxide

Despite the availability of a large range of tools, many people prefer to cope in old-fashioned ways. Hydrogen peroxide, a cheap remedy for ear congestion. When it is used, oxygen is released, which contributes to the destruction of sulfur.

The substance is injected into the ear using a syringe without a needle or pipette. Half a pipette of the product is poured for half a minute. When the sulfur disulfide bonds are broken, a characteristic hiss will be heard. After that, the head is tilted so that the solution leaves the ear. The therapy is repeated up to 5 times a day. For more information on how to treat the ear with peroxide, see here.

Conduct treatment is acceptable if the patient is sure that he has a sulfur plug. It is forbidden to use the procedure when otitis media develops in the ear, there is a foreign body, perforation of the eardrum has occurred, and also if the patient is hypersensitive to the agent.

Waxol

Than suffering from congestion with sulfuric plug, it is better to drip drops based on olive oil into the ear. Vaxol simultaneously has anti-inflammatory, antimicrobial, antifungal and cerumenolytic effects.

Due to its emollient and moisturizing properties, the drug slows down the production of secretions, it envelops the ear cavity, preventing the formation of a plug during water procedures. In the treatment of drops are used twice a day for five days. As a preventive measure, it is enough to instill once a week.

Vaxol for ear plugs

Before using the product, the bottle with drops is warmed by hands, then each ear cavity is irrigated with a sprayer. Next, do a light massage of the tragus. One bottle of prophylaxis is enough for six months. For people with perforation of the membrane and allergy to olive oil, the drug is prohibited.

Conclusion

Since the organ of hearing is one of the main instruments of perception, one should closely monitor its safety. As hygiene, you should not rely on ordinary cleaning, it is better to use drops that have antibacterial properties that can quench the development of pathogenic bacteria.

In addition, the active substances of cerumenolytics purposefully narrow the pores, and also have a peeling effect on the dead cell layer of the ear canal walls.

Drops from traffic jams in the ears allow you to keep the cleanliness and health of the hearing organs. They provide the required care for the external auditory canal. The human ear is a complex system that allows the body to perceive sounds. The hearing organs are exposed to external factors every day. A modern person cannot imagine his life without headphones, phones and hearing aids. At the same time, the ears become vulnerable to external adverse influences. This leads to an increase in the production of earwax, the accumulation of which contributes to the formation of plugs.

The amount of sulfur produced in the ear of each person depends on the structure of the auditory organs and genetic predisposition. Some other factors can also contribute to the formation of sulfuric plugs, for example, the long-term presence of foreign objects in the auditory canal. Increased secretion of sulfur contributes to the use of cotton swabs for cleaning the ears. Plugs in the ears are often formed in the elderly, this is due to the age characteristics of the body, in particular, the aging process. The increased production of sulfur can be associated with many reasons, it should be able to distinguish from poor hygiene, which prevents the natural removal of ear secretions.

How to detect the presence of cork in the ears?

This condition may not manifest itself for a long time until the plug closes the auditory canal. Therefore, they do not pay attention to it for a long time. A characteristic symptom of the presence of sulfur plugs is hearing loss, often observed after bathing and shampooing. When water enters the ear, the sulfur plug increases in size and blocks the auditory canal, which contributes to hearing loss. It can be located both on the eardrum and near it.

Often the cork irritates the nerve roots, which causes dizziness, coughing and vomiting. In this case, it is necessary to seek help from an otolaryngologist, since constant contact of sulfur with the eardrum can contribute to the development of otitis media. Most often, the accumulation of sulfur in the ears can be seen with the naked eye, but it is not recommended to remove it mechanically. A cotton swab helps to push sulfur deep into the auditory canal, in addition, a foreign object can injure the eardrum.

An otolaryngologist will be able to get rid of the cork, the process of its removal is quite simple: this procedure is performed by mechanical removal or dissolution. There are several types of ear plugs - soft, dry, hard. The method of treatment depends on the type of sulfur accumulation present in the patient.

Types of ear drops

Drops from sulfur plugs are used to clean the ears by dissolving the accumulated sulfur. The specialist selects certain means depending on the individual characteristics of the human body. Drops from sulfur plugs are called cerumenolytics. All such drugs are divided into 2 categories - water-based drops and oil-based products.

Water-based preparations include ear drops:

• Remo Wax,
• A-cerumen.

Preparations of the second group contain camphor or olive oil, these include:

• Waxol,
• earex,
• and others.

Remo Wax

Separately, it is worth talking about the drug used to clean the ears - Remo-Vax drops. They help to remove dead cells, cleanse the external auditory canal, prevent the development of inflammatory and infectious diseases after the removal of sulfur deposits. Remo-Vax ear drops tighten pores and moisturize the skin of the ear canal, they are suitable not only for removing wax plugs, but also for ear care. The tool can be used to care for the ears of children of any age, nursing and pregnant women. It does not contain chemicals that can cause allergic reactions, as part of the drug there are no antibiotics.

A convenient bottle ensures high safety of use, which is very important when treating young children. Despite the fact that the drug has no contraindications, you should consult your doctor before using it. To prevent the formation of ear plugs, it is recommended to use drops once a month. To soften and remove plugs, the drug is used according to the instructions. One package is designed for a course of treatment or 4 months of prophylactic use. Not only the use of drops helps to avoid the accumulation of wax in the ears, regular cleaning and care of the ears is also necessary.

A-cerumen

Another, no less effective means for removing sulfuric plugs is A-cerumen, which contains surfactants found in soap. They prevent the deposition of sulfur on the skin of the external auditory canal. Sulfur contains a large amount of fats, surfactants contribute to their dissolution and breaking into smaller components. The sulfur is then easily removed with water.

Hydrogen peroxide is a simple and effective ear wash for earwax. When it enters the ear, oxygen begins to form, its bubbles soften the sulfur plug, contributing to its rapid removal from the auditory canal. Drops with sea water, due to the content in them of elements that contribute to the destruction of sulfur, allow you to easily and safely remove it from the ear. Cerumenex Ear Cleaning Liquid contains triethanolamine, which helps to soften and quickly remove plugs from the ears.

They soften the skin, dissolve and remove sulfur plugs. The basis of Vaxol ear drops is olive oil, Earex drops contain a mixture of 3 cosmetic oils. All the drugs described above contribute to the rapid elimination of the problem and the prevention of its reappearance. It is not recommended to use drops to remove cerumen plug without a doctor's prescription, you can harm the health of your ears.

With excessive formation of earwax, sulfur plugs form in the ears, which can be removed with the help of special drops. The most common means for dissolving sulfur accumulations in the auditory canal include A-Cerumen, Remo-Wax, Vaxol, Otex.

Sulfur plug in ear canal

Earwax is produced in humans to protect the hearing aid from dust particles, insects, and dead skin cells.

Every day, up to 2 thousand glands in the skin of the auditory canal produce about 20 g of earwax, which, when combined with particles of desquamated skin epithelium, the secretion of the sebaceous glands, forms a viscous viscous mass.

Normally, the released mass is removed naturally when chewing, swallowing, talking, but if too much sulfur is released, it thickens, forming a cork.

Its formation is accompanied by hearing loss, noise in the ear. Careless cleaning of the auditory canal with cotton swabs or other mechanical devices contributes to blockage of the ear.

Cleaning the ear with a cotton swab, you can inadvertently:

• compact the accumulation of sulfur;
• injure the auditory canal;
• break the integrity of the eardrum, pushing sulfur deep inside.

A buildup of earwax usually forms first in one ear. The first sign of an excess of its formation is a unilateral hearing loss. If the accumulated mass is closely adjacent to the eardrum, then symptoms such as:

• dizziness;
• nausea;
• dry cough.

The danger of the close proximity of sulfur to the eardrum lies in the risk of infection and the development of otitis media.

Ear wax drops

To dissolve earwax, the pharmacological industry produces 2 types of drops from plugs in the ears with the names:

• Otex, A-Cerumen, Aqua Maris Oto, Colace, Audispray, Remo-Vax, Stopotit - water-based;
• Waxol, Cerustop, Klin-Irs, Earex, Otosan - containing oils.

When should medicines not be used to dissolve sulfuric plug?

Contraindications for the use of means for dissolving earwax are:

• broken integrity, defects of the tympanic membrane;
• chronic otitis;
• transferred purulent otitis media;
• earache;
• discharge from the auditory canal of fluid;
• children's age - medicines should be used from the age indicated in the instructions for use.

Medicines manage to soften the mass accumulated in the auditory canal, and in some cases, its remnants are not washed out of the ear, but are tried to be removed with a cotton swab. You should not do this because:

Incorrect use of a cotton swab

With a careless movement, you can firmly imprint a piece of earwax, soft as plasticine, into the eardrum.

1. After drying, the wax will shrink in size and deform the eardrum, which will cause pain, and sometimes very severe.

When choosing drops for dissolving cerumen plugs in the ears in children, it is especially important to choose a medicine:

• does not cause skin irritation or allergies in the child;
• suitable for age.

Water based drops

Audispray is a product designed to get rid of wax plugs in the ears, made on the basis of sea water. It acts slowly, clearing the auditory canal from the accumulation of earwax and impurities.

The tool is suitable for the prevention of excess sulfur with frequent use of earplugs, headphones. But Audispray will not cope with a dense mass, for example, Remo-Wax should be taken against it.

Remo-Vax is suitable both for cork prevention and for dissolution. For the prevention of ear plugs for elderly people using a hearing aid, it is enough to instill the medicine into the auditory canal 1 rub/month.

If it is required to dissolve an old dense sulfur plug, then the ears are treated with Remo-Vax for 3 days in a row in turn. First, one ear is treated, for which you need:

• warm the bottle in your hands to room temperature;
• lie on your side, pull the earlobe down, drip 20 drops of the product into the auditory canal, trying to let the liquid flow down its back wall;
• withstand without getting up, 20 - 60 minutes;
• lie on the other side, let the liquid with the dissolved sulfur plug flow out;
• rinse with water from a syringe.

After a three-day treatment of one ear, if there is an accumulation of sulfur in the other ear, the accumulated mass is dissolved in the other ear. Remo-Wax ear drops act gently, painlessly get rid of cerumen plug.

The dissolution of earwax is provided by the mink oil contained in Remo-Wax, which is very similar in composition to human sebum. Due to this, the cork is enveloped and well separated from the surface of the auditory canal.

A-Cerumen

The composition of A-Cerumen includes surface-active compounds that contribute to the dissolution of accumulations of earwax. A-Cerumen softens the cork, transfers it to a semi-liquid state.

It is possible to bury the product, according to the instructions for use, from the age of 2.5 years. More information about A-Cerumena is described on the page "How to care for your ears".

A common folk way to remove even dense sulfur plugs from the ears for most adults is the use of 3% hydrogen peroxide in the form of ear drops. Read about how to use peroxide to clean the ear canal on the page "Clog in the ear, how to remove."

Oil drops

As a basis for the production of drops that dissolve earwax, almond, peanut, camphor, olive oil are used. Oil drops have an anti-inflammatory effect, help soften and moisturize the skin.

The composition of Otosan ear drops contains, in addition to olive oil, essential oils of geranium, currant, clove, juniper. The drug is allowed from the age of 18, it is recommended for the prevention of cork formation and for its removal.

As a preventive measure, the ears are treated (4 drops in the ear canal) once a week. If you want to remove ear wax, instill 4 drops up to 4 times a day in a row for 3 to 5 days.

Waxol

Spray Vaxol contains pharmacologically 100% olive oil, which:

• breaks up sulfur buildup;
• eliminates irritation;
• prevents infection.

To completely remove the sulfur plug, Vaxol drops are injected into the ears, then the tragus of the auricle is massaged for better distribution of the agent along the walls of the auditory canal.

If the cork is of a soft consistency, then such a treatment for 5 days will help to get rid of the accumulation of sulfur completely.

Earex

Olive oil is also part of Earex drops, designed to remove ear plugs. The agent is instilled 2 rubles / day. in a week. The medicine can be used to get rid of plugs in the ears in children from 5 years old.

The tool is harmless for young children. But the fact is that children under the age of 5 must definitely get advice from an otolaryngologist before using the drops.

A doctor's consultation is essential to rule out the possibility of a skin infection or ear problems, which are especially common in children under 5 years of age.

Prevention of cork formation

Removing a buildup of earwax is certainly not a complicated procedure. But when doing it at home, there is always a risk:

• injure the eardrum;
• infect the ear and cause otitis externa or otitis media.

With the help of drops, it is possible to prevent the formation of plugs with the narrowness of the auditory canals and with excessive formation of earwax.

Ear hygiene products are allowed to be used during pregnancy and during breastfeeding. In the absence of a violation of the integrity of the membrane, the drugs do not penetrate into the blood and do not have a systemic effect on the body.

To eliminate the problem of the formation of sulfur plugs in the ears, it is enough to treat the auditory canal once a month with drops of Remo-Wax, A-Cerumen, Otosan or other means to remove plugs from the ears.

In the auditory canal of the ear, sulfur is constantly formed. There is nothing wrong with that. On the contrary, it is completely normal and even necessary to maintain the health of the hearing organ. Sulfur protects it from harmful external influences, and also plays the role of a moisturizer for the tissues of the ear canal. However, if this protective substance is produced too actively, problems begin to appear in a person - hearing gradually deteriorates.

What to drip into the ear with a sulfur plug

For treatment, the otolaryngologist usually prescribes suitable medications. The most effective in this case are drops for the ears. Most often, doctors prescribe such drugs for sulfur in the ears:

• "Remo Wax"
• "A-Cerumen"
• Hydrogen peroxide (alcohol)
• "Klin-Irs".

Let's consider them in more detail:

The use of alcohol in high concentrations can provoke a burn of the skin of the auditory canal. Peroxide will be effective if the amount of sulfur accumulation is negligible. It can be used only after making sure that there are no dermatological problems, otherwise you can do harm that is not comparable to sulfuric plug.

1. "Klin-Irs" - ear drops from sulfur plugs, which is an innovation of Israeli scientists and physicians. The basis of this unique preparation is an olive oil derivative containing active chemical compounds. It is used for softening, subsequent dissolution and, finally, removal of sulfur deposits. The tool launches the natural cleansing mechanism, and the gentle method of introducing drops into the ear canal makes it possible to maintain a uniform pressure of the liquid jet. Thus, you can not be afraid to injure the eardrum.

Which drug to prefer

post hoc

When choosing ear drops that dissolve sulfur plugs, it must be taken into account that some cerumenolytics can be effective in some people, while helping others very little. For example, the same well-known "A-Cerumen" can very quickly and efficiently deal with a sulfuric plug in one person, but will not help another. Therefore, when choosing, you should not rely on the words of acquaintances or relatives who claim that such and such a drug immediately helped them. It helped them, but for you, it may turn out to be useless.

Sulfur plugs are not the same for all people. They vary in size and consistency. Also a significant factor is the presence of concomitant pathologies - some of them may be contraindications for the use of a particular remedy. The age of sulfur deposits is also important. All of the above means that cerumenolytic drops, of course, will be useful, but to what extent - this question remains unanswered without a preliminary examination by an otolaryngologist.

The content of the article:

Plugs in the ears are one of the consequences of neglect of personal hygiene. They are formed in both adults and children, but the elderly are most susceptible to this. Their appearance requires urgent intervention, since with a long presence in the ear canal, otitis media can develop and hearing deteriorates, and this is not to mention the appearance of severe discomfort over time.

• Read about EAR CLEAR

What is a sulfur plug?

It is a compaction of the secret produced by the sulfur glands in excess and accumulates in the ear canal, as well as settling on the walls of the auricles. This formation consists of immunoglobulins, glycoproteins, lipids, hyaluronic acid and enzymes. But the main percentage in it still falls on dead and exfoliated skin cells.

The sebaceous secret in the usual sense is just earwax, it is its accumulation that leads to the formation of such plugs. But this is not a necessary consequence, it happens only after these accumulations have solidified. Usually they are not visible from the outside; such a foreign body can be considered only if it does not lie very deep. In some cases, there may even be several.

Due to the formation of sulfur plugs, there is usually a complete or partial obturation of the ear canal. Basically, the seal appears next to the eardrum, from where it is most difficult to get a foreign body.

Reasons for the formation of sulfur plugs

The prerequisites for the formation of a cork can be:

• Otitis. This is an otolaryngological, acute or chronic, inflammatory disease of the ear. It is medium and external, purulent and catarrhal. Often it is supplemented by large accumulations of sulfur.
• Increased humidity in the room. Its indicator in the apartment should be in the range of 60-65%. To avoid an increase in these figures, it is necessary to ventilate the rooms every day and do a general cleaning once a week.
• Dermatitis. This is a disease of the skin, manifested in their irritation, redness, inflammation and severe itching. Most often it occurs in a chronic form and is associated with stress. Chemical agents, low temperatures, drugs act as irritants.
• Frequent use of headphones. Because of this, the natural process of removing wax from the ear is disrupted and the external auditory canal is irritated. The combination of these two factors increases the likelihood of compaction of the formation.
• Dusty air. This is especially true for those who work with sand, cement, flour. But there is a certain risk in the case of rare cleanings in the house. This is a rare cause, which rather complements others, and is not independent.

Important! The likelihood of large accumulations of wax in the ears is higher in people who wear hearing aids.

The main symptoms of sulfur plugs

Signs of this phenomenon include:

1. . It can be both strong and weak, depending on the size of the formation and its location in the passage. Usually its build-up is noted in the evening, and a decrease in the morning.
2. Painful sensations. Their characteristic feature is the difficulty of elimination with analgesic tablets. Their manifestations may intensify closer to sleep and disappear in the morning. They are very similar to migraines with otitis or trigeminal neuritis.
3. dizziness. This symptom usually occurs along with tinnitus and migraine. At the same time, a person is most often not bothered by nausea, weakness, or apathy. Vertigo appears with a sharp change in body position, in particular, after sleep.
4. Hearing loss. This symptom occurs with complete obturation of the auditory canal and after the removal of the plug, it usually disappears immediately. It is noteworthy that often a person with one ear, where there is no education, hears quite well.

If the plug is large, you may experience a feeling of fullness in the ear or the presence of a foreign body in it, and you often hear your own voice when talking or chewing sounds when eating.

What folk remedies should be used to remove sulfur plugs?

The main purpose of their use is to soften the seal, so that later it can be quickly washed out without damaging the eardrum and ear canal. Candles can be used both once and several times in case of large clusters. These methods should be used with extreme caution in young children and pregnant women.

Baking soda to remove earwax

After their connection, the composition should be covered with a lid, shaken and held for 2-3 minutes so that the soda is completely dissolved.

In the finished product, you need to moisten a tourniquet twisted from gauze, which will need to be carefully inserted into the ear canal to a depth of 1 cm and left for 30-40 minutes. After that, since you can’t get to the cork in your ears with your fingers, you should try to rinse them with clean water from a syringe.

For washing, tilt your head to one side and pour warm water into the cavity, while not pressing hard. The cork should come out literally at the same moment, but if this does not happen, it will be necessary to repeat the procedure the next day and do this until the problem is resolved.

Onion to remove earwax

This tool is prepared like this:

• Peel a medium sized onion.
• Grind it on a grater.
• Squeeze out all the juice from the vegetable using cheesecloth.
• In proportions 1:1, dilute the resulting liquid with boiled, but already cooled water.

Instead of water, vodka or boric alcohol can be added to onion juice. In this case, it is necessary to adhere to the proportions of 1: 4 and bury the passages 2 times a day, 3 drops. For some time after the procedure, the skin may burn a little, discomfort should pass in 5-10 minutes. If this does not happen, wash the composition well.

After softening the cork, rinse the ear with warm water using a syringe or the same syringe. At this time, the head should be kept at a slight inclination, so that the affected ear is above the line of the eyes.

Vegetable oils to remove plugs from the ears

Oils should be natural, cold-pressed, unrefined. They should be used warm, preheating to a temperature of 37 degrees.

1. Sunflower. It has excellent emollient properties, regenerates the skin well and prevents damage when trying to get the cork out.
2. Almond. It can be taken as cosmetic, sold in small bottles in pharmacies, and food, which is often bottled by weight. It has a sweet smell that lingers on the skin and needs to be washed off with soap.
3. Hemp. It has a slightly greenish tint, a pungent odor and a liquid consistency, obtained from the hemp fruit plant. This oil absorbs quickly and really softens the seal.
4. olive. Among all oils, this is one of the most expensive, it is sold mainly in the form of a food product, which must be used to treat passages.

If you choose a folk remedy for cerumen in the ears in the form of a compress, then you will need to moisten the gauze cut twisted into a spiral in the oil composition and put it into the passage, leaving it for one hour. After that, you should draw warm water into the syringe (5 ml) and, under slight pressure, gently, tilting your head to one side, introduce it into the blocked passage. Then you need to wipe the skin with a dry cloth, preferably made of cotton. To soothe it, it is proposed to lubricate the surface with petroleum jelly.

You can improve the results and solve the problem even faster by combining several types of oils, while mixing hemp and sunflower oils is not recommended, since they are similar in composition, consistency and a number of other indicators, being, in fact, analogues of each other.

Note! In some cases, the cork may soften only in places and, accordingly, will not come out completely. Then you need to repeat all the steps or contact the ENT.

Homemade candles to eliminate sulfur plug

The procedure for making candles from corks:

1. Cut off the bark from the aspen, dry it and, leaving a small branch for ease of use, cut out the cone. Its dimensions should be as follows: diameter - 2.5 cm at the top and 5 cm at the bottom, height - 40 cm.
2. Melt fresh beeswax in a water bath, which needs about 3 tbsp. l.
3. Draw even linen or cotton fabric into strips, the width of which should be at least 5 cm, and the length is equal to the height of the already prepared bark.
4. In the wax melted in a water bath, holding the edges, dip the resulting tapes so that they are completely covered with the product. Leave them here for 2-3 minutes for complete and even soaking.
5. Treat the prepared aspen bark mold with olive oil and, avoiding the appearance of voids, tightly tie it with a tape dipped in wax. If, despite careful wrapping, gaps still remain in some places, simply cover them with wax using a brush.
6. Cool the candle and remove the base in the form of a bark. As a result, you will be left with a thin wax tube, which you need to use to remove the cork.

It is impossible to treat with ear candles if there is pus in the ear canal, injuries of the external passage, damage to the eardrum. A contraindication to this is an allergic reaction of the body to bee products, as well as hearing impairment, especially if their etiology is not clear.