Many people think they need to remove the earwax in the ears with Q-tips or other cleaning methods. But doctors have long said it is unsafe, and the American Academy of Otolaryngology – Head and Neck Surgery has published a new guideline on cerumen impaction that reiterates that point.
The guideline presents new medical evidence and updates its recommendations so doctors can help identify patients with cerumen impaction who may benefit from intervention.
Cerumen impaction, which is an accumulation of earwax in the ear canal that either causes symptoms – pain, itching, a sensation of fullness, ringing in the ears, drainage, or a cough – or prevents the ear from being adequately examined, is very common. It is estimated that there are 12 million doctor visits per year for cerumen impaction, CEENTA Otolaryngologist Christopher Jones, MD, said. In 2012, for example, $46.9 million was spent on cerumen removal in Medicare patients alone.
The guideline's first statement is that doctors should educate their patients with cerumen impaction on proper ear hygiene. Ears are self-cleaning, Dr. Jones said. The ear is designed to clear wax from the middle part of the ear canal out to the opening of the ear canal.
“We, as doctors, obviously have a huge opportunity for education here, as 92 percent of people surveyed believed that their ears needed to be cleaned,” Dr. Jones said.
Doctors agree that attempts to clean the ears may make cerumen impaction worse, Dr. Jones said. A study of a group of children confirmed that those whose ear canals were cleaned with cotton-tipped swabs had higher rates of cerumen impaction.
Injuries to the delicate structures of the ear are also not uncommon. One study showed that almost 1 out of 10 people who clean their ears have suffered some sort of injury to the ear, Dr. Jones said. These injuries include skin abrasions and eardrum perforations.
The guideline also made specific recommendations against ear candling. Studies have shown that candling of the ears does not produce a “chimney effect” to draw wax out of the ears, nor do the candles “melt” the wax so that the wax will come out in the days after the procedure, Dr. Jones said. The Food and Drug Administration agrees and has issued a warning against ear candles, warning that serious injury can occur even when used as directed by the manufacturer.
There are some special groups, such as the elderly, the cognitively impaired, and hearing aid users, who might need their ear canals cleaned, Dr. Jones said. If a doctor does recommend a patient remove their earwax, the patients should tell their doctor of any history of prior ear surgery or eardrum perforation. Patients with these conditions should not perform ear canal irrigation; instead, it should be done by an otolaryngologist to prevent severe dizziness and/or damage to the middle or inner ear.
The guideline also states that products used to soften wax may be helpful before irrigating the ears, whether at the doctor’s or at home, Dr. Jones said. Water and saline may be as effective as commercially-available, oil-based preparations used to soften wax.
This blog is for informational purposes only. For specific medical questions, please consult your physician. Dr. Jones practices in our Fort Mill, Lancaster, and Rock Hill, SC offices. To make an appointment with Dr. Jones, call 704-295-3000.