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Last year, I read on a newspaper that a research found that we do not need, or should not, clean our ears as the earwax comes out naturally and sticking in cotton swabs can damage our ears.

Is my information accurate? Can anyone provide a summary and reference to the actual research?

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@user unknown, when I said news paper I meant actual paper, so no link. I didn't find anything, hence the question. –  Oxwivi Aug 12 '11 at 13:57
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@Oxwivi - I was once told basically do not go any further than you can get your little finger. Soap and water on the exterior part of your ear is not just fine but important part of cleaning yourself. This should take care of the ear wax on your head phones. If it does not then you may have a condition or an extreme buildup in your canal you may want to see a doctor. –  Chad Aug 12 '11 at 14:53
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You don't need to stick anything into your ears - my girlfriend and her entire family clean their ears using hydrogen peroxide. I think it's disgusting and unncessary, but the only backing for that opinion is that I don't don't do it, and my ears are fine. I'd be very interested in an answer to the title question. –  BlueRaja - Danny Pflughoeft Aug 12 '11 at 19:13
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There seem to be two questions here: Is it necessary to clean the ear canal? Is it safe to clean the ear-canal? The answers to these might be different. Please edit to clarify. –  Oddthinking Aug 13 '11 at 3:55
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To the answerers, or would be answerers: Please avoid posting yet another "don't stick a screwdriver in your ear" answer. That's not what is being asked here. 1) research, not crappy sites; 2) is it hygienically necessary? –  Ebenezer Sklivvze Aug 13 '11 at 6:41

3 Answers 3

up vote 21 down vote accepted

First of all: is it true that earwax (or cerumen) comes out naturally from the ear?

Yes it is. The purpose of ear wax is to trap particles that may enter the ear from the outside, and bring them out of the ear canal.

From S. Gelfand - Essentials of audiology

Cerumen is a waxy substance that is supposed to be in the ear canal, where it serves lubricating and cleansing functions and also helps to protect the ear from bacteria, fungi, and insects. The cerumen is produced by glands in the cartilagenous portion of the ear canal and migrates out over time.

[cut]

Impacted cerumen is an accumulation of wax in the ear canal that interferes with the flow of sound in the eardrum. Impacted ceumen occurs naturally in many patients who produce eccessive amount of cerumen, which builds up over time. It is also the fate of many Q-tip wielding patients who inadvertently pack cerumen farther back into the canal (and frequently against the eardrum) in an ironic attempt to clean their ears

Should earwax be removed?

The American Academy of Otolaryngology says not to, unless it presents a medical risk.

From their website

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 all 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


Various methods exist to remove cerumen. Wikipedia lists:

A number of softeners are effective; however, if this is not sufficient, the most common method of cerumen removal is syringing with warm water. A curette method is more likely to be used by otolaryngologists when the ear canal is partially occluded and the material is not adhering to the skin of the ear canal. Cotton swabs, on the other hand, push most of the earwax further into the ear canal and remove only a small portion of the top layer of wax that happens to adhere to the fibres of the swab.

There is also quite a bit of literature on the matter.

This paper (bare in mind that it was written in 1990, so it may not be reflecting the current situation), surveys 289 practitioners about "the methods of removing ear wax [...] and the incidence of associated complications".

Ear wax removal: a survey of current practice - Sharp et al. 1990

The 289 replies received (92% of the study group) indicated that each doctor saw an average of nine patients (range five to 50 or more) requesting the removal of ear wax per month (table I). The initial medical assessment was made by 179 general practitioners (62%). No medical assessment was made by 23 (8%); these patients were referred directly to the practice nurse. The remaining 87 (30%) offered examination by either the doctor or nurse.

The most used method of wax removal was syringing a ceruminolytic agent (something that melts the wax, such as oil or bicarbonate or special formulations), either done directly by the doctor or by a nurse.

The paper reports that

Complications had been experienced by 105 practitioners (38%) and included perforation, canal lacerations, and failure of wax removal. The removal of occlusive wax improved hearing by a mean of 5 dB over the frequencies analysed.

and concludes that:

About 44000 ears are syringed each year in the area and complications requiring specialist referral are estimated to occur in 1/1000 ears syringed. The incidence of complications could be reduced by a greater awareness of the potential hazards, increased instruction of personnel, and more careful selection of patients.

A more recent systematic review of clinical trials can be found in

The safety and effectiveness of different methods of earwax removal: a systematic review and economic evaluation. - Clegg et al. 2010

They analyzed 22 randomised controlled trials and 4 controlled clinical trials, using different types of softeners, with or without irrigation.

They report that:

On measures of wax clearance Cerumol, sodium bicarbonate, olive oil and water are all more effective than no treatment; triethanolamine polypeptide (TP) is better than olive oil; wet irrigation is better than dry irrigation; sodium bicarbonate drops followed by irrigation by nurse is more effective than sodium bicarbonate drops followed by self-irrigation; softening with TP and self-irrigation is more effective than self-irrigation only; and endoscopic de-waxing is better than microscopic de-waxing. AEs (adverse events) appeared to be minor and of limited extent. Resuts of the exploratory economic model found that softeners followed by self-irrigation were more likely to be cost-effective [24,433 pounds per quality-adjusted life-year (QALY)] than softeners followed by irrigation at primary care (32,130 pounds per QALY) when compared with no treatment. Comparison of the two active treatments showed that the additional gain associated with softeners followed by irrigation at primary care over softeners followed by self-irrigation was at a cost of 340,000 pounds per QALY. When compared over a lifetime horizon to the 'no treatment' option, the ICERs for softeners followed by self-irrigation and of softeners followed by irrigation at primary care were 24,450 pounds per QALY and 32,136 pounds per QALY, respectively.

They conclude that:

Although softeners are effective, which specific softeners are most effective remains uncertain. Evidence on the effectiveness of methods of irrigation or mechanical removal was equivocal. Further research is required to improve the evidence base, such as a RCT incorporating an economic evaluation to assess the different ways of providing the service, the effectiveness of the different methods of removal and the acceptability of the different approaches to patients and practitioners.

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And we have a winner! Great answer, now I know for sure I should not use cotton swabs. Again, thanks for going through all the trouble collecting the data. –  Oxwivi Aug 14 '11 at 17:02
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@Oxwivi: no problem. Hope nobody will go through my browsing history though :P –  nico Aug 14 '11 at 17:40

It is a good idea to remove earwax in order to protect your earphones or to not gross out other people. However, you only need to clean the ear for this, and not the ear canal, and you should certainly not use Q-tips. While excess earwax buildup can cause wax blockage, the more common cause of wax blockage is people pushing the wax deeper into the ear canal when cleaning their ears with Q-tips.

In other words (from the "prevention" section from the NIH page linked above), when you clean your ears

Never attempt to clean the ear by placing any object into the ear canal, such as a Q-tip. It is better to clean the outer ear canal by using a cloth or paper tissue wrapped around your finger.

Or said a bit differently: don't use anything smaller than your finger in your ears.

And if you're really one of the people that build up so much ear wax that you get blockage even without abusing Q-tips:

People who have frequent blockages may benefit from weekly irrigations.

Which means that a trained person flows warm (body-warm, anything else is very uncomfortable) water into your ear with a syringe to wash out the earwax. Don't do this at home, because you may blow out (in) your eardrum.

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There are a couple of issues here:

  1. Sticking anything into an ear, for the purpose of cleaning it or otherwise, is dangerous and can result in ruptured eardrums as well as other damage. My doctor said "nothing should be inserted into an ear that is smaller than an elbow".
  2. Ear wax does indeed come out naturally. Mostly, but not always. If your earwax doesn't come out naturally, then the issues above still mean you shouldn't clean out your ears yourself (or get any unskilled person to do it). Your doctor will clean your ears using a syringe technique. You can help it out by putting mineral oil, or olive oil, in the ear, which softens the wax.

Source:my doctor. Had this done yesterday. Also: this article and this and this and this and this.

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What exactly does count as 'inserting into the canal'? The area around the opening can be easily cleaned by fingers, but is cleaning in the opening dangerous? –  Oxwivi Aug 12 '11 at 13:59
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I find it extremely difficult and uncomfortable to reach my ear with my elbow in order to clean it. –  ghoppe Aug 12 '11 at 18:45
    
@Oxwivi The canal is the opening, so cleaning around the opening is fine. Cleaning in the opening is risky. –  DJClayworth Aug 16 '11 at 14:05
    
I heard the same thing about the elbow from my doctor many years ago. That doctor as Dr. Coupland, father of writer Douglas Coupland. :) –  Kaz Aug 23 at 18:02

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