Medical “gas fuse”: quickly and gently eliminates cerumen

As people’s life expectancy increases, patients with health problems typical of the elderly and senile age have become more common in the practice of doctors. In the field of geriatrics, one of the most common human health problems is hearing loss (deafness), which occurs due to blockage of the external auditory canal with a sulfur plug. Usually, the cerumen is small in size, increases slowly for a long time, does not completely block the ear canal and therefore practically does not interfere with hearing. In this context, many people may not be aware of the presence of cerumen. However, with increasing time, some cerumen can reach a very large size and become a sulfur plug. As a result, at some point, the sulfur plug can tightly close the ear canal and stop the transmission of sound vibrations through the air in the external ear canal to the eardrum. This dramatically impairs human hearing. In such a situation, many people try to clean and/or rinse the ear canal on their own. However, not everyone succeeds and not always. Therefore, some people have to seek medical help from an otorhinolaryngologist. In situations where the patient is at the doctor’s office late, the cerumen often becomes very large and solid. Therefore, its removal from the ear canal in the conventional way is difficult, and the process of removing the sulfur plug can take several hours.1,2

In recent years, 3% hydrogen peroxide has been recommended for removing sulfur plugs (as well as other foreign bodies) from the external auditory canal.1,2,3,4 A ready-made (over-the-counter) solution of 3% hydrogen peroxide in a volume of several drops to several milliliters should be injected into the ear canal without heating. However, the effectiveness of such a hydrogen peroxide solution is not high enough, and it does not ensure reliable and urgent removal of the sulfur plug in each patient.

Recently, researchers have shown that the effectiveness of standard solutions of 3–6% hydrogen peroxide can be significantly increased by the physical‒chemical conversion of hydrogen peroxide from an antiseptic into an “oxygen fuse.”5 For this purpose, standard solutions of hydrogen peroxide at room temperature (24–26°C) with acidic activity are recommended to alkalize to a pH of 8.4 while baking soda and heating to a temperature of 37–45°C.6,7,8 This “gas fuse” was developed for the immediate destruction of thick purulent masses due to the formation of carbon dioxide gas bubbles. A solution of 2.7–3.3% hydrogen peroxide and 0.9–10.0% sodium chloride was proposed as such a drug, which was saturated with carbon dioxide due to the creation of an overpressure of 0.2 atm (Russian patent No. RU 2331441).9 The second medical “gas fuse” was designed to detonate thick and sticky purulent masses due to the rapid formation of oxygen gas bubbles formed by the catalase cleavage of hydrogen peroxide into water and molecular oxygen. This drug was a solution of 3 ± 0.3% hydrogen peroxide and 5–10% sodium bicarbonate (Russian patent No. RU 2360685).10 The results of laboratory tests of these medicinal “gas fuses” on isolated sulfur plugs have shown that these gas fuses of biological masses have powerful destructive activity because of the excessively rapid process of gas formation in the sulfur plug. It was found that injecting such solutions inside the sulfur plugs literally immediately explodes them, scattering sulfur plug fragments at high speed at a distance of up to 1 m.

On this basis, it was concluded that it is impossible to use these medicated fuses inside the external ear canal, as their explosive activity may cause rupture of the tympanic membrane and damage the auditory apparatus.

A special warm alkaline hydrogen peroxide solution with weak “explosive” activity and high safety inside the ear canal was subsequently developed, and an unusual way of using it was proposed (Russian patent No. RU 2468776).11 A safe but effective medicamentous “oxygen fuse” of sulfur plugs is a solution of 0.3–0.5% hydrogen peroxide and 1.7–2.3% sodium bicarbonate heated to 42°C. In turn, the new original method of its application consists of injecting a medicated “oxygen fuse” inside the sulfur plug. Moreover, the “oxygen fuse” is injected under visual control until complete infiltration of the sulfur plug is achieved. The invention provides optimal alkaline hydrolysis of lipid and protein‒lipid complexes that form the basis of the mass of the sulfur plug, as well as the physical destruction of the mass of the sulfur plug through the process of interstitial “cold boiling,” resulting from the formation of oxygen gas bubbles due to catalase cleavage of hydrogen peroxide into water and molecular oxygen with an intensity that excludes damage to the hearing aid. The use of the invention in volunteers has shown that compliance with the proposed formulation of a medicinal “oxygen fuse” sulfur plug and the technology of its injection into a sulfur plug ensures complete destruction and dilution of the sulfur plug and its transformation into a fluffy white oxygen foam one minute after a single application of the drug. In this case, the foam flows out of the external auditory canal on its own.

Consequently, this invention showed that these “gas fuses,” i.e., hydrogen peroxide solutions, provide a process of intratissue “cold boiling,” alkaline saponification and hydrolysis of lipid and protein‒lipid complexes. These drugs are intended for topical application. They are most effective when injected into a selected biological mass, particularly a sulfur plug, which is able to turn into fluffy oxygenated foam 1 minute after a single application (Figure 1).

Figure 1.

“Gas fuses” enable quick “cold boiling” of the cerumen.