The good, the bad and the 'Ewww' of earwax removal

Published October 22, 2012

| The Wall Street Journal

Some 12 million Americans visit medical professionals annually for earwax removal. Millions more have it done at spas and ear-candling parlors, which theoretically suck out earwax with a lighted candle. North Americans also spent $63 million last year on home ear-cleaning products, from drops to irrigation kits, according to market research firm Euromonitor International.

On Internet health forums, people wax rhapsodic about the guilty pleasure of having their earwax removed—though some wonder if it's wrong to enjoy it so much.

Doctors strongly discourage using cotton swabs or ear candling to remove earwax and say that unless it's causing bothersome symptoms, earwax should be left alone.

Officially known as cerumen, earwax is part of the ear's own cleaning system, designed to stop incoming dust, dirt, bacteria—even bugs—in the ear canal and ferry them out again. The wax and trapped debris are propelled along by the movements of the jaw, at about the same speed that fingernails grow. When it reaches the ear opening, the wax usually dries, flakes and falls out, often without the human host noticing.

The process isn't always smooth. Having too much earwax, or wax that is too dry or too sticky, can create a buildup. Much of that is genetically determined.

 "When it comes to earwax, choose your parents well," says Richard Rosenfeld, chair of otolaryngology at SUNY Downstate Medical Center in Brooklyn.

Wearing ear-bud headphones, hearing aids or ear plugs for long periods can also interfere with orderly extrusion.

When excess earwax hardens or gets pushed back down the canal, it can become impacted, which afflicts approximately 10 percent of children, five percent of healthy adults and up to 57 percent of older patients in nursing homes, according to the American Academy of Otolaryngology—Head and Neck Surgery.

Symptoms of earwax buildup include a feeling of fullness, itching, vertigo, pain, tinnitus (a persistent ringing in the ears) or coughing—due to a nerve pathway that connects the ear with the diaphragm, explains Dr. Rosenfeld, who co-authored the American Academy of Otolaryngology's 2008 guidelines for treating earwax.

Excess earwax is also the most common cause of partial hearing loss—and the most treatable.

Removing it at home is an option—if you can do it safely.

That doesn't mean poking cotton swabs, bobby pins or any other implement into the ear to retrieve it, doctors implore. Putting anything into the ear canal risks piercing the eardrum. In fact, attempts to dig earwax out generally pack it in further—"like loading a Civil War cannon," says Rod Moser, a physician assistant at Sutter Roseville Pediatrics, Roseville, Calif.

That edict also includes imaginative ear-cleaning implements such as bamboo ear spoons and miniature Samurai swords.

Frequent cleaning can also strip the protective wax from the ear canal lining, leaving it exposed to moisture and vulnerable to the infection. 

Instead, doctors recommend softening impacted earwax with a few drops of mineral oil, baby oil, commercial ear drops or hydrogen peroxide. Then allow the loosened wax to work its way out naturally.

If it still needs help, try gentle irrigation with a bulb syringe or tilt your head in the shower, say doctors. After a few minutes, straighten up and let the water run out again. 

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