Leave That Ear Wax Alone

While many people feel they need to remove ear wax—technically called cerumen and a mixture of secretion, hair and dead skin—it is actually protective since it has lubricating and antibacterial properties, said Dr. Peter Roland, an ear specialist at the University of Texas Southwestern Medical Center at Dallas. He chaired a panel that released new guidelines Friday from the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

The guidelines are the first comprehensive clinical recommendations meant to help health-care professionals identify patients with impacted wax and treat them properly. Panel members reviewed scientific studies and sought expert opinion to create the guidelines.

“The conclusion is that the mere presence of ear wax does not require anything,” Roland said. If the ears are functioning, and there is no problem, most people should do nothing. And that includes resisting the urge to use a cotton-tipped swab to clean out the ear, he said.
Using a swab can actually drive excess wax in further, he said, and then medical attention is often needed to remove it.

Certain people need to pay more attention to their ear wax status, he said. Those who wear a hearing aid, Roland said, “are much more likely to develop problems with ear wax.” That’s because the hearing aid “prevents the ear from doing its job,” which is to clean out excess ear wax naturally.

As people age, ear wax problems are more common, too, he said, with those over age 65 more likely to have problems than younger people
Hearing aid wearers should get their ears cleaned once or twice a year by a health-care professional to avoid wax buildup, which can cause hearing aid feedback or even damage the device.

When ear wax blocks 80 percent or more of the ear canal diameter, it can result in reversible hearing loss.

About 12 million people in the United States seek medical care each year for impacted ear wax, according to the guidelines. The panel advises the use of wax-dissolving agents such as water and saline to dislodge it by a professional. Irrigation, manual removal with special instruments or ear syringes are other options.

The guidelines advise against the use of cotton-tipped swabs, oral jet irrigators and ear candling (the use of cone-shaped candles that are lit to draw out the wax).

The new guidelines make sense, said Dr. Chester Griffiths, an ear specialist at Santa Monica–UCLA Medical Center & Orthopaedic Hospital, and an assistant clinical professor of surgery at the University of California, Los Angeles, David Geffen School of Medicine.

“These guidelines are followed already by the majority of ear-nose-throat doctors,” he said. The written recommendations may now help other specialists, such as pediatricians, care for patients with ear wax problems, he said.

Insight into the proper care of the ears


Why does the body produce earwax?
What is the recommended method of ear cleaning?
When should a doctor be consulted?
and more…

Good intentions to keep ears clean may be risking the ability to hear. The ear is a delicate and intricate area, including the skin of the ear canal and the eardrum. Therefore, special care should be given to this part of the body. Start by discontinuing the use of cotton-tipped applicators and the habit of probing the ears.

Why does the body produce earwax?

Cerumen or earwax is healthy in normal amounts and serves as a self-cleaning agent with protective, lubricating, and antibacterial properties. The absence of earwax may result in dry, itchy ears. Most of the time the ear canals are self-cleaning; that is, there is a slow and orderly migration of earwax and skin cells from the eardrum to the ear opening. Old earwax is constantly being transported, assisted by chewing and jaw motion, from the ear canal to the ear opening where it usually dries, flakes, and falls out.

Earwax is not formed in the deep part of the ear canal near the eardrum, but in the outer one-third of the ear canal. So when a patient has wax blockage against the eardrum, it is often because he has been probing the ear with such things as cotton-tipped applicators, bobby pins, or twisted napkin corners. These objects only push the wax in deeper.

When should the ears be cleaned?

Under ideal circumstances, the ear canals should never have to be cleaned. However, that isn’t always the case. The ears should be cleaned when enough earwax accumulates to cause symptoms or to prevent a needed assessment of the ear by your doctor. This condition is call cerumen impaction, and may cause one or more of the following symptoms:

Earache, fullness in the ear, or a sensation the ear is plugged
Partial hearing loss, which may be progressive
Tinnitus, ringing, or noises in the ear
Itching, odor, or discharge
Coughing

What is the recommended method of ear cleaning?

To clean the ears, wash the external ear with a cloth, but do not insert anything into the ear canal.

Most cases of ear wax blockage respond to home treatments used to soften wax. Patients can try placing a few drops of mineral oil, baby oil, glycerin, or commercial drops in the ear. Detergent drops such as hydrogen peroxide or carbamide peroxide may also aid in the removal of wax.

Irrigation or ear syringing is commonly used for cleaning and can be performed by a physician or at home using a commercially available irrigation kit. Common solutions used for syringing include water and saline, which should be warmed to body temperature to prevent dizziness. Ear syringing is most effective when water, saline, or wax dissolving drops are put in the ear canal 15 to 30 minutes before treatment. Caution is advised to avoid having your ears irrigated if you have diabetes, a perforated eardrum, tube in the eardrum, or a weakened immune system.

Manual removal of earwax is also effective. This is most often performed by an otolaryngologist using suction, special miniature instruments, and a microscope to magnify the ear canal. Manual removal is preferred if your ear canal is narrow, the eardrum has a perforation or tube, other methods have failed, or if you have diabetes or a weakened immune system.


Why shouldn’t cotton swabs be used to clean earwax?

Wax blockage is one of the most common causes of hearing loss. This is often caused by attempts to clean the ear with cotton swabs. Most cleaning attempts merely push the wax deeper into the ear canal, causing a blockage.

The outer ear is the funnel-like part of the ear that can be seen on the side of the head, plus the ear canal (the hole which leads down to the eardrum). The ear canal is shaped somewhat like an hourglass—narrowing part way down. The skin of the outer part of the canal has special glands that produce earwax. This wax is supposed to trap dust and dirt particles to keep them from reaching the eardrum. Usually the wax accumulates a bit, dries out, and then comes tumbling out of the ear, carrying dirt and dust with it. Or it may slowly migrate to the outside where it can be wiped off.


Are ear candles an option for removing wax build up?

No, ear candles are not a safe option of wax removal as they may result in serious injury. Since users are instructed to insert the 10” to 15”-long, cone-shaped, hollow candles, typically made of wax-impregnated cloth, into the ear canal and light the exposed end, some of the most common injuries are burns, obstruction of the ear canal with wax of the candle, or perforation of the membrane that separates the ear canal and the middle ear.

The U.S. Food and Drug Administration (FDA) became concerned about the safety issues with ear candles after receiving reports of patient injury caused by the ear candling procedure. There are no controlled studies or other scientific evidence that support the safety and effectiveness of these devices for any of the purported claims or intended uses as contained in the labeling.

Based on the growing concern associated with the manufacture, marketing, and use of ear candles, the FDA has undertaken several successful regulatory actions, including product seizures and injunctions, since 1996. These actions were based, in part, upon violations of the Food, Drug, and Cosmetic Act that pose an imminent danger to health.

When should a doctor be consulted?

If the home treatments discussed in this leaflet are not satisfactory or if wax has accumulated so much that it blocks the ear canal (and hearing), a physician may prescribe eardrops designed to soften wax, or he may wash or vacuum it out. Occasionally, an otolaryngologist (ear, nose, and throat specialist) may need to remove the wax using microscopic visualization.

If there is a possibility of a hole (perforation or puncture) in the eardrum, consult a physician prior to trying any over-the-counter remedies. Putting eardrops or other products in the ear with the presence of an eardrum perforation may cause pain or an infection. Certainly, washing water through such a hole could start an infection.

What can I do to prevent excessive earwax?

There are no proven ways to prevent cerumen impaction, but not inserting cotton-tipped swabs or other objects in the ear canal is strongly advised. If you are prone to repeated wax impaction or use hearing aids, consider seeing your doctor every 6 to 12 months for a checkup and routine preventive cleaning.

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