Have you ever thought about earwax? Even if you haven’t thought about it, you may routinely stick cotton swabs in your children or your own ears to clear out wax. Did you know that was a very bad idea? A recently updated report on all aspects of earwax (doctors call it cerumen) has just been published with all the answers to your earwax questions.
The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a detailed report on how to deal with earwax that has also been endorsed by consumer groups, and the professional societies of Pediatrics, Audiology, Internal Medicine, and Nursing. Why should you care? Rarely, impacted cerumen can cause problems especially with hearing and, more commonly, unnecessary attempts to remove earwax can cause problems as bad as broken eardrums. The main problem is that patients, parents, and even some professionals just cannot resist trying to remove earwax even if it’s not necessary. A summary of dos and don’ts for ear care from the report can be found here.
Earwax is a combination of the dead surface cells shed by the lining of the external ear canal mixed with oily secretions. This combination is designed to slowly migrate out of the ear drum and clear the canal of dirt and obstructions. The external ear canal is usually self-cleaning and we do not have to help it clear debris. Unfortunately, I have seen many children over the years come in with blocked and bleeding ear canals because of obsessive and over-aggressive clearing by parents.
The new report says that in general parents and medical professionals should leave earwax alone. Cotton ear swabs such as Q-tips do not really remove earwax as much as push the wax in and cause it to dam up. The old medical joke is "never put anything smaller than your elbow in the ear canal." Even doctors or nurses should only try to remove earwax if the patients is having hearing problems because of the wax, having ear pain with no obvious cause, or in a patient like a young child or someone with developmental delay with a high fever unable to communicate about pain.
In a few cases, cerumen has to be removed. The earwax cannot come out normally in those who wear hearing aids and the build-up worsens hearing problems. In older adults, especially those that use cotton ear swabs a lot, what is thought to be age-related deafness can be resolved with simple earwax removal. My late grandmother-in-law thought I was worthy of her granddaughter after I convinced her to go to an ENT doctor and he restored her hearing by removing impacted wax.
One should never remove wax simply because it is there. If not causing a problem leave it alone. This is especially true in some ethnic groups, such as people whose ancestors came from northeast Asia, where thick hard earwax is normal and causes no problems.
How should earwax be removed? The report says that many methods work including instrument removal (using special curettes or forceps), washing out with water, saline, hydrogen peroxide, or some combinations of these, or suction. They are all safe in the hands of experienced medical professionals. Earwax softeners, usually hydrogen peroxide-like chemicals with brand names like Ceruminex or Debrox, can help medical professionals get the earwax out with less struggle and are safe enough to use sparingly at home.
If earwax removal is medically necessary and the first line medical professional cannot get the impaction removed, sometimes a specialist such as an ENT doctor may be needed. But, in general, leave earwax alone and Do Not Use Cotton Ear Swabs Ever.