October 16, 2012

The Good, the Bad and the Eww of Earwax Removal By Melinda Beck

The following appeared in the Wall St Journal 15/10/2012 & is reproduced out of interest.

Ears are supposed to be self-cleaning. So what’s behind the fascination some people have to help nature along?

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.

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.

Others are unabashed. “I absolutely love to have my ears cleaned,” says Holly Kile, an online business manager from Indianapolis who says she uses cotton swabs daily and has her ears candled every couple of months, as does her 12-year-old son. “It’s generally a competition to see who has the grossest things come out,” she says.

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% of children, 5% of healthy adults and up to 57% 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.

“Those are the happiest patients of my day. You clean out their ears and they say, ‘Oh my God, I can hear!’,” says Sarah Stackpole, an otolaryngologist (also known as an ear, nose and throat specialist) in New York City.

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.

“Do not go mining for it,” adds Mr. Moser, who writes the Family Webicine blog for WebMD

That edict also includes imaginative ear-cleaning implements such as bamboo ear spoons and miniature Samurai swords. (“When you’re going to war, you don’t take just any old weapon—you take the baddest weapon you can find,” boasts the Katana/Sword Ear Pick Cleaner, sold for $10 on Amazon.

Frequent cleaning can also strip the protective wax from the ear canal lining, leaving it exposed to moisture and vulnerable to the infection. “Some people—and you know who you are—are literally addicted to Q-Tipping their ears after every shower,” says Mr. Moser.

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. “Water works just as well as a $10 bottle of ear drops,” says Dr. Rosenfeld. But doctors say high-pressure water streams, including repurposed jet-tooth cleaners, can be damaging.

Over-the-counter “ear vacs” are also generally ineffective. In a British study of 16 patients, published in Clinical Otolaryngology in 2005, none reported hearing better after using an ear vac. There was no improvement in visibility of the ear drum and in fact, no ear wax removed at all.

Another problem with do-it-yourself earwax removal: It’s hard to see what you’re doing, unless you pop for a pricey product like the Coden Ear Scope TV ($150 to $300 on eBay EBAY -0.95%), a lighted magnifying camera that relays images of your ear canal to a computer or TV screen.

Doctors are particularly scornful of ear candling. “I think it’s the work of the devil,” says Dr. Stackpole. The process uses a long, hollow cone-shaped candle. The patient lies down on one side, the bottom of the candle is placed in the ear and the other end is set ablaze, theoretically creating a vacuum inside that draws out the wax.

Many physicians—and the Food and Drug Administration—warn that it can drop hot wax into delicate ear tissues, cause burns or even set hair on fire. Doctors also say it doesn’t work—that brown, gooey stuff inside the cone is candle wax, not earwax.

If softening drops and irrigation don’t work, it’s time to seek professional help—from a nurse, physician’s assistant, primary-care physician or ear, nose and throat specialist. Many rely on drops and irrigation, but some also use small suction devices and a wired loop instrument called a curette. Some ENTs also have microscopes that attach to the wall and give them a 3-D view into the canal.

Using a curette also qualifies the procedure as “surgery,” with its own diagnostic code, and can add as much as $100 to the bill. Mere flushing with water doesn’t warrant the code. Many walk-in clinics at pharmacies also offer earwax removal for $60 to $80, depending on the method.

Even trained specialists can get carried away when it comes to removing earwax, says Robert Folmer, an investigator at the National Center for Rehabilitative Auditory Research in Portland, Ore. He co-authored a 2004 survey in which 11 of 2,400 patients at an Oregon hearing clinic said their tinnitus was caused by a professional earwax removal.

Other studies have found that eardrum perforation, infection and hearing loss occur at a rate of about 1 per 1,000 irrigations. “Some doctors are really determined, but it isn’t like it’s a construction project,” Dr. Folmer says. “You’ve got to be gentle.” He suggests that patients ask a clinician what method they plan to use, and how many times they’ve done the procedure.

Aside from earwax “overproducers,” who can benefit from a professional cleaning a few times a year, doctors say the average person should not require ear cleaning unless the wax is causing bothersome symptoms or impeding a doctors’ ability to examine the eardrum. “I’d tell the doctor, ‘I really like my earwax. Leave it alone, please’,” says Dr. Rosenfeld.

But some patients can’t. Dr. Stackpole says she gives earwax-removal addicts an antibiotic cream to dab at the opening of their ears once a day. “I do that rather than telling them to do nothing, because they are not capable of doing nothing,” she says.

As for Holly Kile, she says she’s heard the expert opinion on ear candling—and swears by it anyway. “I know it’s kind of weird,” she says. “All I know is that I feel better after I have it done.”